Management of Methamphetamine Intoxication

Critical Assessment and Management

• The American Academy of Pediatrics recommends determining the patient's core temperature immediately, as methamphetamine intoxication commonly causes life-threatening hyperthermia that requires urgent recognition and aggressive management to prevent mortality from multi-organ failure 1
• Hyperthermia is a major cause of death in sympathomimetic toxicity, presenting with symptoms such as agitation, tachycardia, diaphoresis, and altered mental status 1
• Management of hyperthermia often involves terminating extreme muscle activity through benzodiazepines or, in severe cases, paralysis with nondepolarizing agents and intubation 1
• The American Heart Association suggests that antipsychotics are not the first-line treatment for sympathomimetic toxicity, and benzodiazepines have already been administered as appropriate first-line treatment 2
• The American College of Cardiology recommends that ECG should be obtained but can be performed after assessing for hyperthermia 1, 3
• Urine drug screens do not change acute management and should not delay critical interventions, as the history already strongly suggests methamphetamine intoxication 1, 2
• If core temperature is elevated, initiate aggressive cooling measures immediately, consider paralysis with nondepolarizing agents and intubation for severe cases, and avoid succinylcholine due to risk of hyperkalemia and rhabdomyolysis 1
• Continue benzodiazepines as needed for ongoing agitation, and provide supportive care with IV fluids for potential hypotension 2
• Avoid beta-blockers in acute methamphetamine intoxication due to risk of unopposed alpha-stimulation and worsening hypertension 2, 3