What is Sympathomimetic Toxicity?
Stimulants, substances that increase focus and decrease fatigue, have been misused for hundreds of years because they allow people to stay concentrated and work for longer periods. They are currently used in medicine quite sparingly, particularly for treating attention deficit hyperactivity disorder. However, they are generally used recreationally by people who are looking to stay awake longer or seeking a high.
Unfortunately, the consumption and misuse of stimulants often lead to emergency hospital visits. This is due to potential health problems that arise from taking the substances, either alone or with other drugs. These health problems can affect various bodily systems, particularly the brain and the heart. These issues can develop quickly or over time, but all increase the risk of illness and death. The basic treatment for health problems caused by stimulants usually involves stopping usage of the substance and managing the symptoms. This often includes medications like benzodiazepines, cooling methods, and treatment of other urgent health conditions.
What Causes Sympathomimetic Toxicity?
Acute sympathomimetic toxicity – a form of drug poisoning – happens when certain chemicals mess with the brain’s handling of two key signals, namely norepinephrine and dopamine. These chemicals stop the brain from being able to remove, or “uptake,” these signals where they are sent out between nerves, leading to an overload.
This can be caused by certain drugs, most commonly cocaine. Other substances such as Mephedrone (commonly known as bath salts) and MDMA (like ecstasy and Molly) have also been linked to this type of toxicity.
What these substances have in common is that they make the brain fill up with too much norepinephrine and dopamine. They stay in the spaces between nerve cells, known as the synaptic cleft, for too long, much longer than the body naturally needs. This leads to the symptoms of toxicity.
Risk Factors and Frequency for Sympathomimetic Toxicity
According to a survey by SAMHSA (Substance Abuse and Mental Health Services Administration) in 2014, about 1.5 million people (0.6% of the population) used cocaine or crack. This rate was higher in people aged 18 to 25, who were twice as likely to use cocaine as other adults. In this age group, men were twice as likely as women to use cocaine. Methamphetamine, another commonly misused stimulant, has resulted in many emergency hospital visits across the country. Abuse of such drugs is not limited by socioeconomic status and is found in all aspects of life, from people who are poor to those who are wealthy. These drugs are easily obtainable and, in some cases, relatively easy to manufacture.
Signs and Symptoms of Sympathomimetic Toxicity
People using sympathomimetics, a type of drug, typically experience an increase in certain bodily functions. They may become sweaty, their heart rate and breathing rate may increase, and they may feel overly warm and restless. In some cases, these individuals may also see or hear things that aren’t there (hallucinate) and could even experience seizures in severe cases.
- Becoming sweaty (diaphoretic)
- Increased heart rate (tachycardic)
- Fast breathing (tachypneic)
- Feeling overly warm (hyperthermic)
- Restlessness (agitation)
- Hallucinations
- Seizures in severe cases
Testing for Sympathomimetic Toxicity
When evaluating someone who is using or abusing substances like sympathomimetics (drugs that mimic adrenaline), healthcare providers usually rely on the person’s history and a physical examination. This becomes complex when the person is using multiple drugs, which is often the case with sympathomimetic users. In these situations, relying solely on a physical exam can be deceptive.
An accurate and swift method to determine sympathomimetic use is through a urine drug test, which is both specific and sensitive. If someone used cocaine in the last 1 to 3 days, the test usually comes out positive. However, it’s crucial to note that not all stimulants (uppers, drugs that increase activity in the body) can be easily identified this way because new ones are regularly synthesized (made).
Treatment Options for Sympathomimetic Toxicity
For most drugs that stimulate the sympathetic nervous system, there are unfortunately no specific antidotes. Your doctor’s first priority is to ensure your airway, breathing, and circulation are all adequately protected. Their main aim is to stop any further harmful effects on your brain and heart caused by the action of these drugs.
If you’ve ingested these drugs via your mouth, your doctor might consider using activated charcoal as long as you are still conscious. This can help limit the drug’s absorption in your body. If you suffer from high blood pressure, the doctor might use certain medications such as labetalol or nitroprusside if other drugs like benzodiazepines are not able to control it.
Benzodiazepines, a type of medication, are primarily used to manage any symptoms you might be experiencing. These medications can help manage and prevent seizures, as well as helping calm you down if you’re feeling agitated. They also play a role in preventing a state of extreme agitation known as excited delirium. Your doctor may also administer intravenous fluids to keep you well hydrated and encourage your kidneys to flush out any harmful substances. Passive cooling techniques may be used to regulate your body temperature.
If you show signs of aggression and agitation, your doctor might administer antipsychotic drugs. If you experience seizures, anticonvulsant drugs might be needed. In case of a condition known as rhabdomyolysis, where your muscle tissue starts to break down, aggressive hydration is crucial to protect your kidneys from any damage. Since there is a risk of heart rhythm irregularities, close monitoring of your condition is necessary. Depending on the specifics of your situation, you may need a psychiatric evaluation before you are discharged from the hospital.
What else can Sympathomimetic Toxicity be?
Here are some medical conditions that could be seen in certain cases:
- Amphetamine toxicity (harmful effects from amphetamine drugs)
- Cocaine toxicity (harmful effects from cocaine)
- Delirium tremens (severe alcohol withdrawal)
- Hypertensive emergencies (dangerously high blood pressure)
- Methamphetamine toxicity (harmful effects from methamphetamines)
- Panic disorder (recurring and unexpected panic attacks)
- Phencyclidine toxicity (harmful effects from PCP drug)
- Scorpion envenomation (sting from a scorpion)
- Toxicity from thyroid hormone (harmful effects from too much thyroid hormone)
What to expect with Sympathomimetic Toxicity
Long-term use of certain stimulating drugs can lead to a range of serious health issues, including high blood pressure, overheating of the body (hyperthermia), heart attack, irregular heart rhythms, strokes, and even tears in the blood vessels in the chest and gut area. Furthermore, using these drugs with injections can also result in a serious heart infection known as endocarditis.
If a person comes into the hospital with their body shutting down (a condition known as cardiovascular collapse) and hyperthermia, they usually have a worse outlook for their health in the long term. The prognosis, or outlook, also worsens for people who abuse multiple drugs in combination with alcohol.
