Sympathetic overactivity from fenfluramine-phentermine overdose

A 24-year-old male presented to the emergency department with hyperadrenergic manifestations of fenfluramine-phentermine overdose: tachycardia, mydriasis, fever, diaphoresis, hyperventilation, and combativeness. Sedatives, neuromuscular paralytics, adrenergic antagonists, and mechanical ventilation were required to care for the patient. In addition, the patient had self-inflicted 15% TBSA second-degree burns and developed adult respiratory distress syndrome which required continued intubation and mechanical ventilation for 12 days. The patient had split thickness skin grafts for his leg burns on day 11. He was discharged after a 26-day hospital stay. We are unaware of any previously reported cases of fenfluramine-phentermine overdose with such profound degree of sympathetic storm.