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Amphetamine Toxicity Nursing Guide

Content reviewed by Ann Dietrich, MD, FAAP, FACEP.

Amphetamine Toxicity etiology and epidemiology 

Amphetamine toxicity is often the result of experimental or recreational use of amphetamines, which can rapidly lead to tolerance and increased dosing. This escalation raises the risk of severe toxicity and complications. Amphetamines include both prescription medications and some over-the-counter diet pills, and their abuse is rising in the U.S., Australia, and Europe, particularly among minorities and women. 

Illicit amphetamines are frequently produced in unregulated laboratories, leading to significant variability in purity and potency. These drugs can be consumed orally, inhaled, or injected, with symptom onset varying by route: 

  • Oral ingestion: Symptoms appear after approximately one hour. 
  • Inhalation/injection: Symptoms manifest within minutes; peak plasma concentration occurs within 5 minutes for IV injection, 30 minutes for inhalation or IM injection, and 2-3 hours for oral ingestion. 

Amphetamines mimic the effects of catecholaminergic, dopaminergic, and serotonergic agonists, leading to symptoms similar to those of cocaine but with a longer duration (10-12 hours). 

Amphetamine Toxicity diagnosis 

Emergency department (ED) physicians and healthcare workers must be adept at recognizing and managing amphetamine toxicity. Key diagnostic steps include: 

  • Basic evaluation: If there are no life-threatening symptoms, a detailed lab workup may not be necessary. Treatment focuses on sedation and observation. 
  • Electrolyte and blood glucose testing: Indicated if seizures or altered mental status are present. 
  • Infectious work-up: Required if hyperthermia is present, including: 
    • Urine and blood cultures 
    • Spinal fluid analysis 
    • Wound culture of skin 
  • Coagulopathy monitoring: To detect disseminated intravascular coagulation (DIC). 
  • Rhabdomyolysis screening: Check urine and serum creatinine kinase levels. 
  • Imaging: 
    • Chest X-ray for chest pain or respiratory distress. 
    • CT Scan for brain imaging in cases of seizures or altered mental status. 
  • Additional tests: 
    • ECG for cardiac evaluation. 
    • Lumbar puncture if infection or fever is suspected. 

Management 

Immediate care 

  • ABCs (Airway, Breathing, Circulation): Support respiratory and circulatory functions as necessary. 
  • Airway management: May require intubation; fluids are often needed early in treatment. 
  • Cooling measures: For hyperthermia, use evaporative cooling and ice packs. 
  • Hypertension: Treat with IV phentolamine, nitroprusside, or nitroglycerin. 
  • Pulmonary edema: Managed with nitroglycerin or diuretics. 

Urgent Issues 

  • Cardiac dysrhythmias: Treat with cardioversion, defibrillation, and antidysrhythmic agents. 
  • Severe agitation and seizures: Best managed with titration of benzodiazepines and maintaining a calm environment. 
  • Gastrointestinal decontamination: 
  • Activated charcoal for recent oral ingestion. 
  • Orogastric lavage or whole bowel irrigation if large amounts of amphetamines have been ingested. 

Monitoring and support 

  • Urinary output: Essential, especially if diuretics are used; a Foley catheter may be needed. 
  • Mental health: Monitor for potential violence, confusion, and suicide risk. 
  • Cooling blanket: For hyperthermia management. 
  • Neurological status: Observe for seizures, stroke, and other CNS complications. 

Amphetamine Toxicity nursing care plan 

Assessment 

Assess the individual for: 

  • Mental status changes: Confusion, agitation, disorientation. 
  • Cardiovascular symptoms: Chest pain, palpitations, hypertension, tachycardia. 
  • Respiratory issues: Respiratory distress or pulmonary edema. 
  • CNS effects: Euphoria, dyskinesia, stroke-like symptoms. 
  • GI symptoms: Nausea, vomiting, dry mouth. 
  • Genitourinary: Difficulty urinating. 
  • Skin issues: Needle marks, infected ulcerations, diaphoresis. 
  • Dental: Eroded teeth, often seen in chronic users. 

Nursing diagnoses 

  • Activity intolerance 
  • Anxiety 
  • Decreased cardiac output 
  • Ineffective individual coping 
  • Impaired thermoregulation 
  • Risk for injury 
  • Substance abuse 
  • Violence 
  • Deficient knowledge 

Interventions 

  • ABCs monitoring: Regularly assess and support airway, breathing, and circulation. 
  • Cardiac monitoring: Watch for dysrhythmias, chest pain, and hypertensive crisis. 
  • Mental health care: Maintain a calm environment, avoid physical restraints when possible, and use chemical sedation if necessary. 
  • Neurological care: Treat seizures with benzodiazepines, conduct brain imaging, and monitor for signs of stroke. 
  • Patient education: Discuss the dangers of amphetamine use, emphasize the need for detoxification programs, and provide support for long-term recovery. 

Expected outcomes 

  • Stabilization: Individual will not experience adverse outcomes like hyperthermia, rhabdomyolysis, or end-organ failure. 
  • Effective management: Reduction in symptoms and stabilization with reassurance and sedation. 
  • Long-term care: Patients may need follow-up care for medical complications, addiction treatment, and mental health support. 

Individual/caregiver education 

  • Detoxification programs: Encourage participation in outpatient or long-term addiction management programs. 
  • Risk of amphetamines: Educate on the toxic effects and long-term dangers of amphetamine abuse. 
  • Psychiatric evaluation: Recommend transfer to a psychiatric facility if needed for ongoing treatment of psychosis or paranoid behavior. 
  • Support systems: Emphasize the importance of a strong support system and regular follow-up to prevent relapse. 

ICD-10 Code for Amphetamine Toxicity 

  • T43.621A – Poisoning by amphetamines, accidental (unintentional), initial encounter

FAQs

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2027

References 

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