From the Guidelines
The treatment for methamphetamine toxicity with rhabdomyolysis should prioritize aggressive supportive care, including fluid resuscitation, symptom management with benzodiazepines, and prevention of complications, as supported by the latest guidelines from the American Heart Association 1. The management of methamphetamine toxicity with rhabdomyolysis involves several key components:
- Aggressive fluid resuscitation with intravenous fluids, such as normal saline, to maintain urine output above 200-300 mL/hour and prevent acute kidney injury from myoglobin precipitation in renal tubules.
- Administration of benzodiazepines, such as diazepam or lorazepam, to control agitation, seizures, and hypertension, as they have been shown to relax muscles and treat seizures in the context of sympathomimetic poisoning 1.
- Active cooling measures for hyperthermia.
- Consideration of short-acting agents like nitroprusside or phentolamine for severe hypertension unresponsive to benzodiazepines.
- Urinary alkalinization with sodium bicarbonate to help prevent myoglobin precipitation in the kidneys, aiming for urine pH >6.5.
- Close monitoring and correction of electrolyte abnormalities, particularly hyperkalemia. In severe cases, renal replacement therapy may be necessary, and psychosis or severe agitation may require antipsychotics like haloperidol, although these should be used cautiously due to their potential to lower seizure threshold. The primary goal of treatment is to preserve kidney function and prevent multi-organ failure, addressing both the sympathomimetic effects of methamphetamine and the consequences of muscle breakdown.
From the FDA Drug Label
Manifestations of amphetamine overdose include ... rhabdomyolysis. Treatment Consult with a Certified Poison Control Center for up to date guidance and advice. The treatment for methamphetamine toxicity with rhabdomyolysis is to consult with a Certified Poison Control Center for up-to-date guidance and advice 2.
From the Research
Treatment for Methamphetamine Toxicity with Rhabdomyolysis
The treatment for methamphetamine toxicity with rhabdomyolysis involves several key components:
- Aggressive intravenous fluid resuscitation (IVFR) to improve outcomes of acute renal failure (ARF) and lessen the need for dialysis 3
- Identification and release of any associated compartment syndrome 3, 4
- Measurement of creatine phosphokinase (CK) as a screen for potential muscle injury in patients with methamphetamine toxicity 5
- Monitoring for acute kidney injury (AKI) and rhabdomyolysis, as these conditions are common in methamphetamine intoxication 6
Management of Rhabdomyolysis
The management of rhabdomyolysis in patients with methamphetamine toxicity may involve:
- Urine alkalization with bicarbonate, although the benefit of this treatment is debated 3
- The use of mannitol, although its effectiveness in improving outcomes is unclear 3
- Emergent dialysis for patients with severe kidney injury 4
- Bilateral thigh and leg fasciotomies for patients with compartment syndrome 4
Importance of Early Recognition and Treatment
Early recognition and treatment of methamphetamine-induced rhabdomyolysis and AKI are crucial to limit complications and decrease hospital stay 4, 6