Amphetamine toxicity masked by concomitant γ-hydroxybutyrate (GHB) ingestion

Area of Science:

• Toxicology
• Emergency Medicine
• Pharmacology

Background:

• Polydrug abuse presents diagnostic challenges.
• Gamma-hydroxybutyrate (GHB) is a central nervous system depressant.
• Amphetamines are potent central nervous system stimulants.

Observation:

• A young male presented with altered mental status, initially attributed to GHB intoxication.
• Sympathomimetic symptoms, including tachycardia and hypertension, emerged as GHB effects waned.
• The patient developed acute pulmonary edema, a rare complication of amphetamine toxicity.

Findings:

• Amphetamine intoxication was initially masked by concurrent GHB use.
• Urine toxicology confirmed amphetamine presence.
• Successful management involved supportive care, intubation, and benzodiazepines for agitation.

Implications:

• Clinicians must consider co-ingestions in drug toxicity cases.
• Variable presentations of polydrug abuse require a high index of suspicion.
• Early recognition and management are crucial for favorable outcomes in stimulant toxicity.