Fatal and nonfatal methamphetamine intoxication in the intensive care unit.

Methamphetamine poisoning was confirmed in eight patients admitted to intensive care 1989 through 1992 because of altered mental status and hemodynamic instability. Four patients were male and four were female, ages 20 to 34 years. Five patients were addicts and three were attempted suicides. The most common clinical cardiovascular manifestations were tachycardia and palpitations. Neurological abnormalities included agitation, hallucinations, pupillary dilatation and muscle twitching; profuse sweating was also common. All patients had rhabdomyolysis and four had remarkable elevation of creatinine kinase > 10,000 U/L. Leucocytosis was noted in seven cases. Therapy included aggressive circulatory support with Swan-Ganz monitoring, external cooling and other modalities. The three fatalities (two addicts, one suicide) presented with coma, shock, body temperature 39 degrees-42 degrees C, acute renal failure, metabolic acidosis and hyperkalemia (K 5.6-8.5 mmol/L).