Methamphetamine is a stimulant that comes in powder or crystal form and can be injected, snorted, smoked, or taken orally. It causes increased alertness but also symptoms like agitation, increased heart rate and blood pressure, sweating, and potential for hyperthermia or psychosis. Treatment involves sedation with benzodiazepines to control agitation, treating hyperthermia and hypertension aggressively, and watching for complications like rhabdomyolysis or associated injuries. Methamphetamine users may also be at risk of contamination from toxic chemicals from production sites and can present a risk of violence.

1. A lecture in Toxicology By Dr Asi Peretz
METHAMPHETAMINE AKA TIK

2. WHAT IS METHAMPHETAMINE??
Methamphetamine is a
sympathomimetic amine that
belongs to a class of compounds,
the phenethylamines, with a variety
of stimulant, anorexiant, euphoric,
and hallucinogenic effects.

3. FORMS OF DISTRIBUTION

4. CRYSTALLINE FORM

5. WHAT DOES METH LOOK LIKE?
•Typically an odorless powder that dissolves quickly
in water
•Another form of meth is clear chunky crystals
referred to as crystal meth or ice. Tik
•May be in the form of small brightly colored tablets,
referred to as YABA, mainly in South East Asia

6. HISTORY
Methamphetamine was first
synthesized in 1893. Thirty years
later, pharmaceutical formulations
were introduced as treatments for
nasal congestion and asthma.
Methamphetamine was widely used
by German, Japanese, and American
forces during World War II to
increase alertness and decrease
fatigue.

7. Narcolepsy
ADHD
Obesity(off label)
MEDICAL USES

8. HOW IS METH USED?
• Injected
• Snorted
• Smoked
• Orally

9. CLINICAL FEATURES
Methamphetamine is a
sympathomimetic with a variety of
stimulant, anorexiant, euphoric, and
hallucinogenic effects

10. CLINICAL FEATURES
Clinicians should consider the diagnosis of
methamphetamine intoxication in any
diaphoretic patient with hypertension,
tachycardia, severe agitation, and psychosis.
Patients with methamphetamine intoxication
range from the virtually asymptomatic to those in
sympathomimetic crisis with imminent
cardiovascular collapse.

11. • CNS stimulation(agitation, delerium, or acute psychosis)
• Tachycardia
• Hypertension
• Dilated Pupils (Mydriasis)
• Diaphoresis
• Hyperthermia (variable, may be severe)
SYMPATHOMIMETIC TOXIDROME

12. PROGNOSTIC FACTORS FOR
MORTALITY
In severe intoxication, prognostic factors for
mortality include:
• coma
• shock
• body temperature >39°C
• acute renal failure
• metabolic acidosis
• hyperkalemia (serum potassium 5.6 to 8.5
mmol/L).
• The clinician should anticipate clinical
deterioration and cardiac arrest in any wildly
agitated patient, particularly those requiring
physical restraints to maintain patient safety.

13. LABORATORY ANALYSIS
Routine testing in poisoned patients
Urine tox screen to confirm diagnoses( Do not
withhold treatment pending results)
•Fingerstick glucose
• ECG to assess for conduction system
impairment
• Paracetamol and salicylate levels
• Pregnancy test in women of childbearing age
Basic electrolytes, Urea, creatinine
• Metabolic acidosis, acute renal failure, and
hyperkalemia may be seen in severe toxicity
Creatinine phosphokinase, serum lactate, Liver
functions, and coagulation studies.

15. MANAGEMENT (AGITATION)
Agitation (control with aggressive sedation)
• Benzodiazepines are first line therapy; may
need large doses
• For severe agitation:
- Lorazepam, 4 mg IV, may repeat every 8-10
minutes, titrate to sedation
- Diazepam, 5-10 mg IV, may repeat every 8-10
minutes, titrate to sedation
- If lacks IV access, midazolam 5-10 mg IM, may
repeat every 10 minutes, titrate to sedation
• Consider other agents in cases of
benzodiazepine failure

16. BENZODIAZEPENE FAILIURE
Typical antipsychotic agents (eg, ziprasidone
10 mg IM), butyrophenones (eg, droperidol
2.5 to 5 mg or haloperidol 10 mg given IM
or IV), or combinations of these agents can
be used as adjunctive therapy when high
doses of benzodiazepines do not adequately
control symptoms.
Note: Haloperidol may lower seizure
threshold and is assosiated with Neuroleptic
Malignant Syndrome.

17. CONTROL OF HYPERTHERMIA
Control of hyperthermia (T ≥41.1°C)
involves eliminating excessive muscle
activity. While benzodiazepines alone offer
benefit to moderately ill patients, severely
intoxicated hyperthermic patients may
require paralysis with nondepolarizing
agents, such as rocuronium and
vecuronium, followed by tracheal intubation
and mechanical ventilation.
NB: Succinylcholine is contraindicated
because of the risk of rhabdomyolysis and
hyperkalemic arrhythmias.

18. CONTROL OF HYPERTENTION
Severe hypertension, particularly if refractory to
aggressive treatment with sedatives, may require
treatment with vasodilators (eg, nitroprusside,
nitroglycerin) or alpha-adrenergic antagonists (eg,
Doxazosin(cardura) phentolamine). We suggest
avoiding the use of beta-adrenergic antagonists
(beta-blockers), including labetalol.

19. TREATMENT FAILURES
Failure to aggressively treat agitation –
Uncontrolled agitation results in hyperthermia,
acidosis, rhabdomyolysis, and sudden
cardiovascular collapse. Control of agitation and
chemical sedation is a clinical priority.
Failure to aggressively treat hyperthermia –
Hyperthermia is strongly associated with
mortality and morbidity if not rapidly corrected.

20. TREATMENT FAILURES
●Failure to recognize rhabdomyolysis – A
frequent complication of methamphetamine
intoxication, rhabdomyolysis contributes to renal
failure and hyperkalemia.
●Failure to consider associated illness –
Methamphetamine-intoxicated patients are
frequently the victims of traumatic injury. In
addition, methamphetamine users may suffer
from a range of complications, including:
intracranial hemorrhage, myocardial infarction,
aortic dissection, pulmonary edema or
hemorrhage, endocarditis, injection site abscess,
and placental abruption.

21. TREATMENT FAILURES
●Failure to note risk of contamination –
Methamphetamine synthetic labs are often
contaminated with toxic chemicals. Patients who
work in or have contact with such labs may need
decontamination to prevent poisoning patients
and staff.
●Failure to appreciate the risk of violence –
Methamphetamine-intoxicated patients can
demonstrate a striking degree of violence. The
use of physical and chemical restraints,
personnel, and police is often required to ensure
the safety of care providers and other patients.

22. HIGHLY TOXIC SUBSTANCES
Drain cleaner
Battery acid
Antifreeze
Over-the-counter asthma medicine
containing ephedrine or pseudoephedrine
Match-box striker (Red phosphorous)
Hydrochloric acid
Lye
Lantern fuel
(KCI)

23. THE END
Thank You!