Rhabdomyolysis and Shock After Intravenous Amphetamine Administration

Abstract

Five patients injected with i.v. phenmetrazine or methamphetamine developed marked prostration resembling septic shock, disseminated intravascular coagulation, rhabdomyolysis with myoglobinuria and azotemia. Soon after injection, 4 noted chills, fever, sweats, nausea and abdominal cramps. Within hours, they developed vomiting, myalgias, paresthesias, headache and orthostasis. Cardiorespiratory arrest, accelerated bleeding and noncardiac pulmonary edema were observed in 1. From 4-11 l saline were required in the 1st 24 h to maintain blood pressure and urine output, suggesting that shock resulted from massive intravascular volume loss into necrotic muscle. Treatment by aggressive volume replacement led to the recovery of all.