Med Let 1996;38:43, Nejm 1996;334:965; 1995;333:1267

Pathophys:Overt and silent CNS (Jama 1998;279:376) and cardiac (Nejm 2001;345:351) vasoconstriction; impaired perceptions of overheating (Ann IM 2002;136:785)

Sx:Used nasally or iv, or smoked as "free-base" or "crack"

Neurologic: delirium, seizures, ischemic and hemorrhagic CVAs (Nejm 1990;323:699)

Hyperthermia

Cardiac: MIs and arrhythmias (Nejm 1986;315:1438, 1495), premature atherosclerosis, silent ST elevations on Holter even 3 wk after discontinuation (Ann IM 1989;111:876), false pos CPK-MB elevations, EKG changes of MI only in 36% when actually present

r/o similar but longer acting (12+ h) methamphetamine abuse ("speed," "crystal," "ice") (Med Let 2004;46:62) and w which must avoid haloperidol, which may impede metabolism

Rx:

of agitation: iv benzodiazepines

of chest pain: nitrates plus O₂ and ASA; if not enough use phentolamine, verapamil, or thrombolytics; avoid lidocaine (Med Let 1990;32:93) and labetolol as well as other -blockers, which can result in unopposed -stimulation