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Meth lab old silo12/16/2023 Administration of copious intravenous crystalloids is also recommended to enhance urinary elimination and prevent acute renal failure. For severe hypertension without tachycardia, nitroprusside is recommended as it is easily titrated to effect and has a half-life of minutes. Despite the unfortunate persistence of dogma carried over from a small number (n=7) of cocaine cases, there have been no cases of “unopposed alpha stimulation” reported with beta-blocker use and treatment of methamphetamine toxicity. Both labetalol and metoprolol have the added advantage of being lipophilic, with CNS penetration and antagonism of excess monoamines causing agitation. For tachycardia without hypertension, the beta 1-blocker metoprolol is preferred. įor concomitant tachycardia and hypertension that does not respond to sedation, the combined beta/alpha-blocker labetalol is preferred based on a systematic review from 2015. A common example of this is the “B-52” with its combination of haloperidol (5 mg), diphenhydramine (50 mg), and lorazepam (2 mg). Diphenhydramine is often added to enhance sedation and as prophylaxis against dystonia and akathisia. Combination treatment with benzodiazepines and antipsychotics has been shown to be more efficacious than monotherapy. Antipsychotics, such as haloperidol and olanzapine, are also useful in the management of agitation. Methamphetamine users may be resistant to benzodiazepine treatment. Methamphetamine is secreted in breast milk.īenzodiazepines represent first-line treatment for methamphetamine toxicity but frequently require repeated and escalated dosing to achieve the effect. Methamphetamine use during pregnancy can be fatal to the mother and fetus from placental vasoconstriction resulting in spontaneous abortion. Injectors frequently present with abscess and cellulitis, which they often blame on a "spider bite." Dental examination usually reveals severe caries, especially of the maxillary teeth "meth mouth.” This results from maxillary artery vasoconstriction, xerostomia, and poor hygiene. Skin findings include delusions of parasitosis, and chronic skin-picking may result in neurotic excoriations and prurigo nodularis ("speed bumps"). Renal failure may occur from rhabdomyolysis, necrotizing angiitis, acute interstitial nephritis or tubular necrosis. Severe abdominal pain may result from acute mesenteric vasoconstriction methamphetamine has also been associated with the formation of ulcers and ischemic colitis. Acute noncardiogenic pulmonary edema and pulmonary hypertension may result from acute and chronic use, as well as from adulterants introduced during intravenous use such as talc or cornstarch. Acute and chronic cardiomyopathy results directly from methamphetamine cardiac toxicity and indirectly from chronic hypertension and ischemia intravenous use may result in endocarditis patients may present with dyspnea, edema, and other signs of acute congestive heart failure (CHF) exacerbation. Hypotension may be observed with methamphetamine overdose with profound depletion of catecholamines. Chest pain from cardiac ischemia and infarction, acute aortic dissection or an aneurysm has been associated with methamphetamine abuse. Tachycardia and hypertension are frequently observed, and atrial and ventricular dysrhythmias may occur. Īcute and long-term methamphetamine use may lead to abnormal findings on examination of the following systems: cardiovascular, CNS, gastrointestinal, renal, skin, and dental. Methamphetamine abusers tend to be mendacious and mistrustful of health care professionals when describing their drug history. More recently, epidemic abuse has been described in adolescents. In the USA, methamphetamine abusers are predominantly white males in their 30s and 40s. Over the past decade, all regions of the United States have experienced a significant increase in the number of persons using the drug and emergency department visits. The southwestern and west coast states (including Hawaii) reported the highest prevalence of abuse from the 1970s to the 1990s. The street name “crank” refers to biker gangs’ transport of methamphetamine hidden in their motorcycle crankcase. Initially, Japan experienced a high prevalence of abuse in the 1950s, followed by the United States in the 1960s. It was used extensively by myriad armed forces in World War II, the Korean War, and Vietnam War. Methamphetamine was initially synthesized in the early 1900s and used unregulated as a nasal decongestant, to enhance alertness, and for weight loss.
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