(meth) increases synaptic levels of the neurotransmitters dopamine, serotonin
(5-HT) and norepinephrine, and has alpha and beta adrenergic agonist effects.
Norepinephrine is responsible for methamphetamine’s alerting, anorectic,
locomotor and sympathomimetic effects; dopamine stimulates locomotor effects,
psychosis, and perception disturbances; and serotonin is responsible for
Adverse clinical cardiovascular
manifestations of meth include: chest pain, palpitations,
shortness of breath, hypertension or hypotension, myocardial ischemia, atrial
and ventricular dysrhythmias, and circulatory collapse.
Animal studies have shown that meth has both positive and negative cardiac
inotropic effects and is directly toxic to the myocardium. In addition
to acute MI in humans, meth has been reported to cause cardiomyopathy, acute
pulmonary edema, and pulmonary hypertension.
- Hypertension is related
to vasoconstriction. It is essential to continually monitor blood pressure,
and renal status. Controlling
agitation is also necessary to prevent further elevation of blood pressure.
Moriya & Hashimoto (2002) reported A case of Cerebral arterial spasm
and hypertension resulting from the administration of meth might
have resulted in intraventricular hemorrhage. According to Goldfrank, et
al. (1998) drugs of choice for treating hypertension include Phentolamine(alpha-adrenergic
antagonist) and nifedipine, nitroprusside, and nitrogycerine (vasodilators).
related to sympathetic stimulation and /or myocardial ischemia.
aortic aneurysm According Anzalone, Crow, & Costalas (2002) aortic
aneurysm can be found in young people after meth abuse.
- Acute Myocardial
Infarction may be a complication of meth use. According to Chen (2007) meth is association with myocardial infarction attributed to accelerated atherosclerosis, hypercoagulable state, and macrovascular epicardial coronary spasm. Ischemia and necrosis can occur at a young age and be manifested by chest
pain, palpitations and dyspnea.
- Cardiomyopathy has been
reported in meth users. According to Wijetunga, Seto
, Lindsay , & Schatz (2003) The pathogenesis is probably similar to that
of cocaine and catecholamine-induced cardiomyopathy. Cellular, animal, and clinical
data support the link between meth exposure and myocardial pathology
adverse effects of methamphetamine on the cardiovascular system are
due impart to excessive catecholamine stimulation.
manifestations of meth use are cardiovascular some pulmonary complications
occur. According to Cruz, Davis, O'Neil and Tamarin (1998), dyspnea
with shallow respirations may be noted within seconds of smoking ice.
Absence of bronchoconstriction and wheezing may be due to the bronchodilating
effect of meth.
- Pulmonary edema according
to Cruz et al (1998) may be associated with the use of ice.
- Pulmonary hypertension
according to Cruz et al (1998) may occur after long standing use of crank
- Many individuals begin
to take some form of meth for the appetite suppressing qualities.
to Goldfrank et.al. (1998) meth causes an increase
of norepinephrine, which causes anorexia. Weight loss may be as
great as 50 -100 pounds. Teenagers are often told that meth is the same
of drug their physician
would order and thus encouraged to try meth. Meth abusers become severely
- Nausea vomiting and diarrhea
may also accompany meth use.
- Gastric lavage and administration
of activated charcoal are recommended if the drug
has been ingested,
but ipecac-induced emesis should be avoided because of the possibility
of inducing seizures, arrhythmias of hypertensive hemorrhages (Beebe
and Walley, 1995).
Central Nervous System:
patients report to the Emergency room due to CNS symptoms. These patients
volatile, and aggressive
and in some cases psychotic.
- The central nervous system (CNS)
actions that result from taking even small amounts of methamphetamine include
activity, decreased appetite, increased respiration, hyperthermia,
- Other CNS effects include
irritability, insomnia, confusion, tremors, convulsions,
anxiety, paranoia, and aggressiveness.
(Stroke) - McGee et al (2004) describe the following
case-A healthy 31-year-old male abstinent from
drug abuse during his recent incarceration
speech, a severe headache, and left-sided hemiparesis
prior to his eventual death 9.5 hours after inhalation of methamphetamine.
On postmortem examination,
of the brain revealed bilateral subarachnoid hemorrhage,
with a prominent intralobar hemorrhage centered
within the right frontal cerebral hemisphere.
of vasculitis, infarction, intraventricular hemorrhage,
or ruptured aneurysm could be observed. While this
the first report of a methamphetamine-related
stroke, this report describes the autopsy findings
of an intracerebral hemorrhage secondary to methamphetamine abuse
on autopsy and compares
the findings and antemortem
history to previously reported methamphetamine
cerebral vascular deaths.
According to Goldfrank et.al.(1998) hyperthermia is a frequent and rapidly
fatal manifestation in
patients . Temperature may
be as high as 104.
External cooling and control of agitation is
recommended. Benzodiazepines are recommended for agitation.
Goldfrank et al (1998) recommend giving
10mg of Diazepam
I.V. and repeating until the patient is calm.
A cumulative dose of over 100 mg., may be needed.
According to Goldfrank et.al. (1998) these are best treated with barbiturates
- Ruptured cerebral (berry)
aneurysms- According to Davis and Swalwell (1996) acute intoxication with
methamphetamine may contribute to formation
of a berry aneurysm by causing transient
hypertension and tachycardia. Their study found the mechanism of death
although some cases also had intracerebral
- Methamphetamine releases
high levels of the neurotransmitter dopamine, which stimulates brain cells,
mood, memory and body movement. It appears to
have a neurotoxic effect, damaging brain
cells that contain dopamine as well as serotonin.
Recent studies in chronic methamphetamine
abusers have revealed severe structural alterations and functional deficits
in areas of the brain associated
with emotion as well as memory. These findings may help account for many
of the emotional and cognitive problems observed in chronic methamphetamine
abusers. Over time, it
cause reduced levels of dopamine, which
can result in symptoms
like those of Parkinson's disease.
- Renal Failure--Vasoconstriction induced acute renal failure can occur alone or in conjunction with cardiorespiratory or vascular problems (Lineberry and Bostwick 2006) .
- Skin Lesions--Skin lesions may include excoriations and ulcers from the users compulsive picking at “meth bugs,” the result of methamphetamine-induced delusional parasitosis. Needle marks from injections, or chemical burns sustained while “cooking” methamphetamine. Cellulitis from poor wound care may require treatment. (Lineberry and Bostwick 2006).
- Burns--the frequency of burn center admissions related to the manufacturing process of Meth is increasing. Meth burn patients have larger burn size, incidence of inhalation injury, and increased morbidity when compared with non-meth burn patients.
- Corneal ulceration -
Chuck, Williams, , Goldberg,, and Lubniewski, (1996) found that Methamphetamine
may cause chronic recurrent, bilateral,
from the use of Ice.
- Rhabdomyolysis- Richards,
Johnson, Stark, and Derlet, (1999) found an association between Rhabdomyolysis
urine screens for meth.
- Acute lead poisoning
is another potential risk for methamphetamine abusers. A common method
lead acetate as a
reagent. Production errors therefore may result in methamphetamine
contaminated with lead. There have been documented cases of acute lead
deterioration involving missing or badly decayed teeth is one hallmark of chronic
methamphetamine abuse. Caries
associated with meth
abuse are thought to be related to three factors: 1) xerostomia caused by the
a subsequent increase in sugared soft drink consumption; and 3) lack
of oral hygiene during extended periods of abuse. Patients in this
risk group usually
for treatment due to severe pain (Shaner 2002).
- Anxiety reactions
the person is fearful, tremulous,
about his physical well-being. Also experienced is an exhaustion
syndrome, involving intense fatigue and need for sleep, and a prolonged
depression, during which
is possible (Merck
- HIV--Lineberry and Bostwick (2006) report that methamphetamine increases libido and reduces inhibition, a synergy that results in increased STD risk for users and their sexual partners. Male meth users who are human immunodeficiency virus (HIV)-positive and engage in homosexual activity report low rates of condom use. They are also more likely to have multiple sex partners and engage in anonymous sex. Robinson and Rempel (2006) report that persons with HIV disease and meth addiction reported using meth to treat HIV-related depression, fatigue, and neuropathic pain. HIV-related diarrhea seemed to diminish with methamphetamine use, although this was not a motivation for use.
- Sexually Transmitted Disease--According to Lineberry and Bostwick (2006) Heterosexual male and female users also are more likely to engage in risky sexual behaviors that include multiple sexual partners, anonymous partners, or unprotected sex. Clinicians should have a low threshold for ordering STD screening for meth abusers and their partners.
manufacture can result in lead poisoning .
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