Agitation in suspected recreational drug use

What it is

A 26 years old man is brought to the emergency department by the paramedics after being found wandering in the street. He has been agitated and fighting with bystanders, and his family reported that he has been partying with friends for the last 2 days. The most likely diagnosis is stimulant toxicity.

Causes and risk

The history taken from him is that he has no PMH, he has been abusing multiple drugs, he smokes heavily, he does not drink ETOH, he has no known allergies, he is not sure about trauma, and he has no psychiatric history.

The diagnosis is written as sympatomimitics toxicity, that is stimulants, and the drugs listed beside it are cocaine, cafiene, amphetamine, and ice, crystals. The table lists cocaine and amphetamines together under sympathomimetics.

How it presents

Vital signs: HR 135, BP 160/79, Sat 100% RA, T 37.1, glucose 8. The pupils are dilated and reactive to light, he is sweating, and there are multiple needle marks. There are no features of injury other than mild bruises at the knuckles.

The features the table gives for sympathomimetics are agitation, tachycardia, HTN and mydriasis.