Pediatric emergency medicine trisk 3149 3149
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hallucinations, agitation, anxiety, paranoia, and vomiting. Seizures, acute kidney
injury, and SVT have been reported.
Treatment generally consists of discontinuation of the drug and symptom-based
supportive care as needed. Benzodiazepines may be useful in managing
significant paranoia, agitation, tachycardia, or seizures. Patients should be
observed at least until normalization of their vital signs and improvement in their
mental status.
STIMULANTS
CLINICAL PEARLS
Stimulants include amphetamines (prescription and illicit
methamphetamine), cocaine, and other newer agents such as MDMA
(“Ecstasy”) and cathinones (“Bath Salts”).
These compounds produce alertness and restlessness at lower doses,
but in high dose cause a dramatic sympathomimetic toxidrome
characterized by hypertension, tachycardia, mydriasis, agitation,
delirium, psychosis, hyperthermia, and seizures.
MDMA toxicity has unique features that include hyponatremia,
serotonin syndrome, and hepatotoxicity.
Amphetamines
Current Evidence
Amphetamines have been used medically to treat narcolepsy, ADHD, obesity,
fatigue, and nasal congestion. Abuse and misuse of ADHD medications
(dextroamphetamine, methylphenidate) is a significant problem in adolescents
and young adults. Several decongestant nasal inhalers continue to add
amphetamine agents that may be extracted and ingested by drug-seeking
adolescents. Use of the amphetamine derivative MDMA (Ecstasy) has recently
demonstrated a resurgence of use in the form of “Molly”—often sold as a white
powder purported to be more “pure” and thus safer than previous iterations of the
drug, however a number of deaths have been reported. Use of this form of
MDMA is particularly popular at concerts, raves, and music festivals. The unique
characteristics of the emerging synthetic cathinones are discussed at the end of
this section.
Many drug users prefer amphetamines over cocaine because the clinical
duration of action is considerably longer than that of cocaine and the smokeable
