Toxicology
Miscellaneous stimulants and street drugs accounted for 46,753 toxic exposures and 186 deaths in 2022.
derivatives), cocaine, methamphetamines, and heroin.
Total numbers are difficult to determine because few of these agents can be detected with current
techniques.
Mechanism of action/toxicity: stimulation of the CNS, peripheral release of catecholamines, inhibition
36)
Common: Confusion, tremor, anxiety, agitation, irritability, mydriasis, tachyarrhythmias
Severe: Hepatocellular necrosis, acute hepatitis, myocardial ischemia, hypertension, cerebral
hemorrhage, seizures, hyponatremia
Treatment
Mostly supportive care with intravenous fluid administration and airway maintenance
Gastric lavage or activated charcoal if within 1 hour of ingestion
BP control with benzodiazepines, α-blocker, or vasodilator (e.g., nitroglycerin, nitroprusside,
nicardipine). Avoid the use of β-receptor blocking agents because of risk of unopposed α-receptor
activity leading to an increase in BP.
| d. | Benzodiazepines for agitation, anxiety, psychosis, and/or uncontrolled hypertension titrated to |
|---|
effect. Haloperidol or phenothiazines may be considered for use (with caution) in patients with
primary psychiatric disorders or dopamine-mediated movement disorders.
Cooling therapy if hyperthermia present
Monitor for serotonin syndrome.
Mechanism of action/toxicity: stimulation of the cannabinoid-1 (CB1) and cannabinoid-2 (CB2)
CB1 receptors modulate glutamate and GABA and are found both peripherally and centrally.
CB2 receptors are located in immune tissue and the CNS and modulate pain and emesis.
Predominantly euphoria or excited delirium
Common adverse effects include:
Psychiatric: Agitation, anxiety, hallucinations, paranoia, catatonia
ii.
Neurologic: Cognitive impairment, ataxia, dizziness, headache, seizures
iii.
Cardiovascular: Tachycardia, palpitations, hypertension
iv.
GI: Nausea, vomiting
Renal: Acute kidney injury, rhabdomyolysis
Treatment
Mostly supportive care with intravenous fluid administration
Benzodiazepines for agitation or seizure activity. Antipsychotics for agitation may be considered
for use (with caution) in patients with primary psychiatric disorders or dopamine-mediated
movement disorders.