Prehospital Care
Patients with acute methamphetamine intoxication are often highly agitated and therefore present a safety risk to not only themselves, but prehospital personnel as well. Furthermore, the patient’s mental function may be significantly impaired and therefore incapable of making an informed decision to refuse treatment and transport. Thus, additional help from emergency medical services providers are sometimes advised before the patient is transported, if possible. Prehospital intravenous access is warranted with or without patient consent. This allows the agitation and for seizures to be treated using intravenous sedatives sooner and giving the patient a better chance at a full recovery.
Emergency Department Care
Most cases of methamphetamine toxicity can be managed supportively as by intravenous administration of required nutriment. In cases of severe overdose immediate supportive care is required. Airway control, oxygenation and ventilation support are needed. For suspected toxic oral ingestions, administration of a laxative, typically a polyethylene glycol (PEG) solution, will be initiated if possible.
Focusing on severe overdoses, terminating methamphetamine-induced seizure activity and arrythmias are of immediate importance. Additionally, correcting hypertension, agitation, cardiac ischemia and rhabdomyolysis are common practices in ER hospital settings for methamphetamine overdose.
Treatment of seizures
Treatment of methamphetamine-induced seizures are treated like other seizures of unknown etiology. Treatment is performed as follows:
- Administer benzodiazepines intravenously (see Medication)
- In the cases where patients do not have IV access, an agent with intramuscular absorption can be used (e.g. lorazepam, midazolam)
- After control of the acute episode, longer-acting agents, such as phenobarbital, may be necessary
- Patients with methamphetamine-induced seizures are at high risk for intracranial hemorrhaging and should undergo CT imaging when able
Treatment of hypertension and tachycardia
If sedation fails to reduce blood pressure, antihypertensive agents such as beta-blockers and vasodilators are effective in reversing methamphetamine-induced hypertension and tachycardia. In regards to the choice of beta-blockers, labetalol is preferred due to its combined anti-alpha-adrenergic and anti-beta-adrenergic effects (see Medication). Additionally, metoprolol has anti-beta-adrenergic effects and easily penetrates the CNS, while also alleviating agitation.
Treatment of agitation
It is common for patients with acute intoxication of methamphetamine to require physical restraint as agitation can make pharmacologic intervention troublesome. This is due to methamphetamine having significant CNS and psychiatric activation. Agitated patients may be treated with haloperidol intravenously (see Medication) to antagonize CNS dopamine receptors thus mitigating the excess dopamine produced from methamphetamine toxicity.
Treatment of cardiac ischemia
The treatment for a patient with methamphetamine-induced cardiac ischemia is no different from standard treatment for acute coronary syndrome. Nitrates, beta-blockers, aspirin, heparin, and morphine should be administered if indicated.
Treatment of rhabdomyolysis
This treatment applies to patients who exhibit severe agitation from methamphetamine or have had prolonged periods of immobilization. Creatine kinase (CK) levels are monitored and management of rhabdomyolysis is performed as follows:
- Administer aggressive volume therapy with IV crystalloid
- Renal function, vital signs, and fluid input and output are closely monitored
- Sodium bicarbonate is administered to prevent precipitation of myoglobin in renal tubules by preventing acidic urine pH
- Early and aggressive fluid and electrolyte treatment of potential rhabdomyolysis can improve the clinical outcome and decrease potential nephrotoxicity
- In severe cases, hemodialysis may be necessary
Long-Term Monitoring
It is often difficult to remove the patient from the subculture of meth, beit the production, distribution, and/or abuse of the drug. This makes it problematic to properly treat addiction. Referral to a psychiatrist and/or a drug treatment center may be advised.
Symptoms of insomnia are a key indicator of methamphetamine withdrawal. Typically, this is coupled with depression and/or anxiety. Withdrawal symptoms typically resolve over two to three weeks, as with depression, though the anxiety may remain.
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