Metamfetamine overdose and abuse
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Hyperthermia: 2 case reports In a case series, a 21-year-old man developed hyperthermia following abuse and overdose of metamfetamine, and a 46-year-old man developed hyperthermia secondary to intake of metamfetamine [durations of treatments to reactions onsets not stated]. Patient A: A 21-year-old man, presented in an altered and unresponsive state following ingestion of metamfetamine [methamphetamine]. Subsequent physical examination showed clear lungs, dilated and reactive pupils, soft abdomen and no rigidity or clonus in extremities. The vitals were as follows: BP 148/84mm Hg, pulse 115 beats/minute, respiratory rate 20 breaths/minute, room air saturation 100% and rectal temperature 42.2°C (hyperthermia). Subsequently, due to his declining clinical course and for airway protection, he was intubated, following admission. Initially, he was treated with a cooling blanket and massage with large ice bags. Despite 46 minutes of active massage with ice bags, his body temperature remained high at 40.4°C. Therefore, his lower body and torso was covered with plastic body bag which was then filled with slurry of ice and water. Over next 39 minutes, his body temperature decreased rapidly from 40.4°C to 36.5°C. Then he was removed from the body bag and dried off. After ice bath removal, his temperature remained below 38°C. From interrogation, it was found that he had consumed 2g of metamfetamine orally (overdose) and some possible balloons filled with metamfetamine (abuse) were also ingested. However, a subsequent CT-scan of abdomen did show any bags. He received supportive care for 9 days in the ICU. He was fully recovered and subsequently discharged at his baseline mental status. The man’s life-threatening hyperthermia was suspected to be cause by metamfetamine consumption. Patient B: A 46-year-old man was brought to the emergency department in unresponsive state. His medical history was significant for hepatitis-C and poly-substance abuse. At admission, he was unresponsive. Subsequent physical examination revealed diaphoresis, tachycardia, dilated pupils, flushed skin and muscle rigidity, but no clonus. The investigation revealed the following: BP 110/85mm Hg, pulse 140 beats/minute, respiratory rate 40 breaths/minute and body temperature 41.8°C (hyperthermia) [duration of treatment to reaction onset not stated]. He was therefore intubated for declining clinical course and airway protection. He was then aggressively cooled by placing in a body bag, which was then filled with ice slurry. Once his body temperature decreased to 38.8°C, he was removed from the ice bag. Within 42 minutes of placing in the ice bag, his body temperature decreased from 41.8°C to 36.9°C. After ice bath removal, his temperature remained below 38°C. Within next 24 hour, he was extubated without any cognitive deficits. It was later revealed that he had received metamfetamine [dosage, route and indication not stated], and the lifethreatening hyperthermia was due to intake of metamfetamine. On the day his was intubated, he took discharge agains
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