Sympathomimetic Poisoning

Sympathomimetic Poisoning is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Direct or indirect stimulation of adrenergic receptors in sympathetic and central nervous systems
  • Often no correlation between dosage and degree of toxicity
  • Cocaine may also block sodium channels of cardiac myocytes, leading to “tricyclic” or class 1a–type dysrhythmias

Pediatric Considerations
  • Sympathomimetic poisoning in children may present similarly to meningitis or other systemic illness
  • Urinary toxicology screening may have a role in discovering sympathomimetic poisoning in children presenting with altered mental status
  • Methylphenidate (Ritalin, Concerta), lisdexamfetamine (Vyvanse), and other sympathomimetics used for ADHD may cross-react with altered mental status

Etiology

  • Sympathomimetic toxicity can result from use of any sympathetically active drug, including:
    • All amphetamines, methamphetamines, and derivatives (ecstasy, MDMA, Molly)
    • Cocaine (including “Speed Ball”) when opioid reversed with naloxone
    • Synthetic cathinones “Bath Salts”
    • Phencyclidine (PCP)
    • Lysergic acid diethylamide (LSD)
    • Decongestants (rare)
  • Drug delivery routes: Inhalation, injection, snorting, or ingestion

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Basics

Description

  • Direct or indirect stimulation of adrenergic receptors in sympathetic and central nervous systems
  • Often no correlation between dosage and degree of toxicity
  • Cocaine may also block sodium channels of cardiac myocytes, leading to “tricyclic” or class 1a–type dysrhythmias

Pediatric Considerations
  • Sympathomimetic poisoning in children may present similarly to meningitis or other systemic illness
  • Urinary toxicology screening may have a role in discovering sympathomimetic poisoning in children presenting with altered mental status
  • Methylphenidate (Ritalin, Concerta), lisdexamfetamine (Vyvanse), and other sympathomimetics used for ADHD may cross-react with altered mental status

Etiology

  • Sympathomimetic toxicity can result from use of any sympathetically active drug, including:
    • All amphetamines, methamphetamines, and derivatives (ecstasy, MDMA, Molly)
    • Cocaine (including “Speed Ball”) when opioid reversed with naloxone
    • Synthetic cathinones “Bath Salts”
    • Phencyclidine (PCP)
    • Lysergic acid diethylamide (LSD)
    • Decongestants (rare)
  • Drug delivery routes: Inhalation, injection, snorting, or ingestion

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