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Major symptoms of intoxication
What are the major signs and symptoms of intoxication and withdrawal for common substances of abuse (cocaine, benzodiazepines, marijuana/synthetic cannabinoids, opiates, nicotine, and amphetamines) and what treatment may be required?
Select Substances of Abuse and Features of Intoxication and Withdrawal and Associated Treatments
| Substance | Intoxication | Withdrawal |
|---|---|---|
| Cocaine | Myocardial ischemia, stroke, rhabdomyolysis, hyperthermia, seizures, hypertension, insomnia Tx: supportive; consider benzos, avoid beta-blockers | Dysphoria (depressed affect), fatigue, sleep disturbance, vivid dreams, psychomotor retardation or agitation Tx: supportive |
| Amphetamines/methamphetamines | Diaphoresis, hypertension, tachycardia, insomnia, agitation, psychosis Tx: consider benzos and antipsychotics as needed | Fatigue, irritability, anxiety, insomnia, psychosis Tx: supportive; consider benzos as needed |
| GABA-R agonists (alcohol, barbiturates, benzodiazepines) | Slurred speech, unsteady gait, impaired memory or attention, confusion, stupor, coma Tx: supportive; consider flumazenil | Tremors, anxiety, irritability, autonomic hyperactivity, seizures, delirium Tx: supportive; substitution of long-acting benzo taper |
| Marijuana and synthetic cannabinoids | Euphoria, anxiety, panic attacks, paranoia, depersonalization, derealization, psychosis Tx: supportive; consider benzos and antipsychotics as needed | Anger, aggression, anxiety, irritability, dysphoria, insomnia Tx: supportive |
| Opioids | Euphoria, anesthesia, pinpoint pupils, somnolence, respiratory suppression Tx: supportive; consider naloxone | Autonomic hyperactivity, restlessness, irritability, pupil dilation, tremor, lacrimation, rhinorrhea, nausea, vomiting, diarrhea, myalgias, arthralgias Tx: supportive symptomatic care; consider methadone or buprenorphine-naloxone |
| Nicotine | Enhancement of alertness and concentration, variably calming or anxiety provoking, appetite suppression, tachycardia, vasoconstriction Tx: supportive | Sweating, frequent urination, gastrointestinal disturbances, drowsiness, bradycardia Tx: supportive; nicotine replacement |
| Hallucinogens | Hallucinations, derealization, pupillary dilation, tachycardia, palpitations, sweating, blurred vision, tremors, discoordination. Tx: supportive; consider antipsychotics as needed | Anxiety, dysphoria, flashbacks Tx: urinary acidification, supportive care |
Tx, Treatment considerations; Benzos, benzodiazepines.
Sources
Adapted from Tetrault JM, O’Connor PG. Substance abuse and withdrawal in the critical care setting. Crit Care Clin 24(4):767–788 (Table 4), 2008.
