Sympathomimetic Toxicity

Excerpt

Stimulants, valued for their ability to enhance focus, sustain attention, and reduce fatigue, have been both medically utilized and illicitly abused for centuries. The current medical use is more limited, most notably in attention deficit hyperactivity disorder, and its recreational use is mostly seen in people seeking euphoria or prolongation of their awake period. Historically, amphetamines, a prototypical stimulant class, were prescribed to soldiers to optimize performance. Notably, methamphetamine was widely distributed to the German military during the Second World War to limit fatigue among exhausted soldiers. Meanwhile, other nations dispensed benzedrine and other amphetamines to their armies.

The use and abuse of stimulants lead to frequent emergency department visits for the evaluation of complications related to their use. These complications cover the entire range of organ systems, most notably the cardiovascular and central nervous systems. Complications may be acute or chronic, all producing an increase in morbidity and mortality. The first-line treatment of sympathomimetic toxicity is the cessation of exposure to the offending agent and management of neuroexcitation and autonomic instability, typically with benzodiazepines, cooling measures, and careful supportive care.