Sympathomimetic Toxicity Workup

Updated: Mar 02, 2021
  • Author: Paul Kolecki, MD, FACEP; Chief Editor: Asim Tarabar, MD  more...
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Approach Considerations

Drugs levels generally are not helpful. However, routine screening for other potentially treatable toxins is recommended (eg, acetaminophen, salicylate).

Measurement of electrolytes, blood urea nitrogen (BUN) and serum creatinine, fingerstick and laboratory blood sugar, and calculation of the anion gap is recommended. Special attention should be given to the sodium level, as there are reports of hyponatremia associated with the use of ecstasy. Significant free-water intake along with sodium loss from excessive dancing (eg, rave dancing) may contribute to the development of hyponatremia. Healthy young women have been reported to be at risk of potentially fatal hyponatremia associated with ecstasy use. [11]

Measure total creatine kinase (CK) levels to check for rhabdomyolysis. Risk factors for developing rhabdomyolysis include delirium, seizures, coma, hypotension, cardiac dysrhythmia, and cardiac arrest.

Obtain an electrocardiogram (ECG) to check for evidence of myocardial ischemia and dysrhythmias. Measurement of cardiac markers (eg, troponins, creatine phosphokinase–MB [CPK-MB]) is also appropriate to screen for cardiac injury. [10]

Performing a urine drug screen is recommended. Urine drug screening for cocaine is fairly sensitive and specific and typically can detect the presence of cocaine if used in the past 1-3 days. Drug screening for amphetamines, however, is not as specific. Standard drug screening typically does not detect the presence of bath salts.

Consider a computed tomography (CT) scan of the head to rule out intracerebral bleeds in unresponsive patients or those with focal neurologic deficits.