Sympathomimetic Toxicity

Aka: Sympathomimetic Toxicity, Sympathomimetic Overdose

1. See Also
   1. Sympathomimetic
2. Causes: Illicit
   1. Cocaine
   2. Amphetamines (MDMA, Methamphetamine)
3. Symptoms
   1. Anxiety
   2. Agitation
4. Associated Conditions
   1. Serotonin Syndrome
   2. Rhabdomyolysis
5. Signs (Mnemonic: Aspirin)
   1. Altered Level of Consciousness
   2. Sweaty
   3. Pulmonary edema
   4. Irritability
   5. Ringing in the ears
   6. Increased Respiratory Rate
   7. Nausea or Vomiting
6. Signs: Systemic Sympathomimetic Effect
   1. Cardiovascular
      1. Arrhythmia
         1. Sinus Tachycardia
         2. Supraventricular Tachycardia
         3. Ventricular Tachycardia
         4. Widened QRS wave duration
         5. Asymptomatic ST Elevation
      2. Severe Hypertension
         1. Aortic Dissection
         2. Cerebral bleeding
      3. Myocardial Infarction
         1. Risk from Coronary Artery constriction
         2. Self limited Chest Pain without EKG change
   2. Peripheral Vasoconstriction
      1. Ischemia at fingers at toes
      2. Ischemia at Kidneys, gut, and spinal cord
   3. Pulmonary
      1. Crack Intravenous
         1. Pulmonary edema
         2. Pulmonary hemorrhage
      2. Crack
         1. Interstitial pneumonitis
         2. Pneumothorax or Pneumomediastinum (with Valsalva)
   4. Central Nervous System
      1. Anxiety or agitation
      2. Paranoia
      3. Delirium
      4. Seizures
      5. Cerebral Vasculitis
      6. Thrombotic or Hemorrhagic Cerebrovascular Accident
      7. Hyperthermia
      8. Mydriasis
   5. Muscle
      1. Acute Rhabdomyolysis
   6. Hepatic
      1. Acute Toxic Hepatitis (similar to Tylenol)
   7. Maternal
      1. Placental Abruption
   8. Newborn
      1. Ventricular Tachycardia
      2. Cerebral Infarction
7. Management: Toxicity
   1. General
      1. See Unknown Ingestion
      2. See Altered Level of Consciousness
      3. Gastric Decontamination
         1. Indicated for <60 minutes from ingestion
   2. Anxiety, Agitation, or Seizures
      1. Benzodiazepines IV (Diazepam or Lorazepam)
   3. Hyperthermia
      1. Rapid cooling
      2. Benzodiazepines IV
   4. Hypertension
      1. Benzodiazepines IV
   5. Refractory Hypertension
      1. Nitroprusside
      2. Phentolamine
   6. Arrhythmias
      1. Avoid Lidocaine if possible (may cause Seizures)
      2. Tachyarrhythmias
         1. Benzodiazepines IV
      3. Prolonged QRS wave duration
         1. Hypertonic Sodium Bicarbonate 1-2 meq/kg
   7. Myocardial Ischemia
      1. Indicated
         1. Aspirin
         2. Nitroglycerin
         3. Calcium Channel Blocker
      2. Contraindicated
         1. Avoid Beta Blocker use if possible
            1. May aggravate coronary Vasoconstriction
         2. Unopposed Alpha action
8. References
   1. Derlet (1989) J Emerg Med 7:157-61