Brenda, a 27-year-old, Native American female, arrived at Lame Deer Clinic Emergency department at 10:30 pm, after her mother found her lying unconscious and choking on her saliva. At the initial evaluation, the nurse noted the following symptoms. Brenda’s pupils were dilated, and her temperature was extremely high. Her blood pressure was abnormally high, and her heart rate was extremely fast.
During the initial evaluation, the doctors immediately ordered fluids to be given to rehydrate her. The doctor then stimulated the contraction of the blood vessels with a machine to increase her blood pressure. At 11:00 pm, while Brenda was being transferred by Help Helicoptor to Saint Vincent hospital in Billings, she began to show signs of a heart attack. The inflight emergency team desperately tried to revive the woman by administering CPR. The effort was successful.
After the helicopter arrived at Saint Vincent, a doctor inserted a tube into the Brenda's vein. Through this tube, a drug was given to control her abnormal heart rate. A nurse checked her blood pressure again, but it was still high. Brenda was then transferred to Intensive Care. About two hours later, she suffered another heart attack. This time, doctors and nurses were unable to revive her, and Brenda died. Following a urine analysis, lab technicians detected that she had ingested a lethal dose of methamphetamine.
Methamphetamine intoxication occurs when the body is presented with an overwhelming amount of drug or drugs, usually because of illegal drug abuse or because of suicide attempts. A lethal dose of methamphetamine varies depending on characteristics of the drug and the user because each person has a different sensitivity to a specific amount of methamphetamine. A toxic level in one person may not be a toxic dose in another. The definition of a lethal dose of methamphetamine may also be complicated by other drugs the user may have taken or by diseases that the person may have developed either as a complication of chronic use or of other causes.
Unlike other drug intoxications, methamphetamine intoxication gives no immediate signs to users. In Brenda’s case, she had no idea that she had just ingested a lethal dose of methamphetamine. Users can take a lethal dose and not instantly realize that they have just done so. An overdose is characterized by a rapid onset of physiological deterioration, eventually leading to a heart attack or stroke. Because of the rapid onset, death proceeds suddenly and unexpectedly.
Severity of signs and symptoms indicate how an intoxication has progressed or is progressing, with severe progression leading to death. Less severe signs and symptoms include those that are exclusive, but also characteristic of severe progression. These signs and symptoms include sweating profusely, rapid breathing, increased heart rate and dilated pupils. Brenda’s first sign that something was terribly wrong was when her heart started beating uncontrollably. She then immediately panicked and thought to herself that she was going to die.
Profuse sweating, rapid breathing, increased heart rate and dilated pupils are all associated with stimulation of the sympathetic nervous system. It is the sympathetic nervous system that accelerates the heart rate, constricts the blood vessels, and raises blood pressure.
Methamphetamine acts specifically on the sympathetic nervous system causing increased release of the neurotransmitter norepinephrine and allowing norepinephrine to remain active by decreasing its uptake. This increase in norepinephrine accelerates the heart rate, constricts blood vessels, and raises blood pressure.
As the heart beats faster, more energy is needed for the body to accommodate the extra workload the heart is producing. As the body uses the energy for bodily functions, some energy is also released as heat in the form of sweat, thus explaining why profuse sweating happens in an overdose. At a certain point, the fluids needed to produce the sweat deplete, causing dehydration. Because the body doesn’t have an effective way to release the heat, the heat accumulates and produces a rise in body temperature.
To treat the rise in temperature, ice blankets can cool the body externally, while special drugs control internal cooling. Drinking liquids prevents excessive dehydration and restores body fluids. The physician assistant at the Lame Deer clinic had given fluid to Brenda in an attempt to rehydrate her.
All of the physiological effects associated with the sympathetic nervous system including increased heart rate, increased blood pressure, and vascular constriction, affect many organ systems, causing heart problems, stroke, and acute kidney failure.
High temperature, rapid onset of kidney failure and cardiovascular collapse together are definite danger signs of physiological regression.
High temperature is associated with the sympathetic nervous system and overworked muscles. As described above, the body reaches a point of dehydration. As a result, the body does not have an effective way to release the heat. The heat then accumulates, raising body temperature.
Long-termed muscle twitching and contraction coupled with hyperthermia lead to muscle breakdown. The byproducts from this breakdown, proteins, then overload the kidney. The kidney is not able to handle this overload.
Kidney failure may be related to high blood pressure and vascular constriction. These cause a decrease in oxygenated blood to the kidney. Again the sympathetic nervous system is involved here. As mentioned before, the sympathetic nervous system constricts the blood vessels. Constriction of the blood vessels results in less flow of oxygenated blood to tissue and cells. A decrease in oxygenated blood then leads to tissue and cell death, in this case, specifically the kidney.
Cardiovascular collapse is also caused by constriction of blood vessels. A decrease in blood flow also leads to tissue and cell death of the heart. And with the diminished efficiency of the heart, the heart's output slowly deteriorates, eventually collapsing. Brenda’s heart had collapsed during the helicopter flight to Billings.
Fatal methamphetamine overdoses have several detrimental prognoses in common. They usually result in direct toxic effects, followed by multiple organ failure. Death from a methamphetamine overdose is associated with the rapid onset of kidney failure and with the circulatory system collapsing. A large percentage of patients who die usually have symptoms of coma, shock, inability to pass and secrete urine, and muscle twitching. A combination of these negative physiological effects killed Brenda.
Other complications associated with methamphetamine intoxication include, pulmonary edema, hypoglycemia, intracerebral hemorrhage, hyperthermia, hypertension, confusion, delerium and hyperactivity.
Fortunately, Brenda’s story is fictional depiction of what could take place during a methamphetamine overdose, but similar stories are happening on reservations because use of methamphetamines by Native Americans has increased. Use and abuse of methamphetamines has serious short-term effects on the physiology of the body.
· autonomic nervous system--The part of the nervous system that regulates involuntary function, including the activity of the cardiac muscle, smooth muscles, and glands. It has two divisions: the sympathetic nervous system and the parasympathetic nervous system.
· blood pressure--The pressure exerted by the circulating volume of blood on the walls of the arteries and veins, and the chambers of the heart.
· CPR--A basic emergency procedure of life support, consisting of artificial respiration and manual external cardiac massage.
· coma--A state of profound unconsciousness, characterized by the absence of spontaneous eye openings, of response to painful stimuli, and of vocalization.
· dehydration--Excessive loss of water from body tissues.
· heart attack--Necrosis of a portion of cardiac muscle caused by obstruction in a coronary artery through either atherosclerosis or a thrombus or a spasm.
· heart rate--The pulse, calculated by counting the number of QRS complexes or ventricular beats per minute.
· Hypertension--A common often asymptomatic disorder characterized by elevated blood pressure persistently exceeding 140/90 mm Hg.
· Hyperthermia--A state in which an individual’s body temperature is elevated above his or her normal range.
· hypoglycemia--A less than normal amount of glucose in the blood, usually caused by administration of too much insulin, excessive secretion of insulin by the islet cells of the pancreas, or dietary deficiency.
· intracerebral hemmorhage--A type of hemorrhagic stroke in which bleeding directly into the brain occurs.
· kidney (renal) failure--Inability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.
· methamphetamine--A central nervous system stimulant. Among the more serious adverse reactions are various manifestations of central nervous system excitation, increase in blood pressure, arrhythmia and other cardiovascular effects, nausea, and drug dependence.
· neurotransmitter--Any one of numerous chemicals that modify or result in the transmission of nerve impulses between synapses.
· norepinephrine--An adrenergic hormone that acts to increase blood pressure by vasoconstriction but does not affect cardiac output.
· parasympathetic nervous system--Part of the nervous system that slows heart rate, increases intestinal peristalsis and gland activity, and relaxes sphincters
· prognoses(prognosis)--A prediction of the probable outcome of a disease based on the condition of the person and the usual course of the disease as observed in similar situations.
· pulmonary edema--An accumulation of extravascular fluid in lung tissues and alveoli, caused most commonly by congestive heart failure.
· rhabdomyolysis--A potentially fatal disease of skeletal muscle characterized by myoglobulinuria. It is also associated with acute renal failure in heatstroke.
· shock--An abnormal condition of inadequate blood flow to the body’s peripheral tissues, with life-threatening cellular dysfunction.
· stroke--An abnormal condition of the brain characterized by occlusion by an embolus, thrombus, or cerebrovascular hemorrhage, resulting in ischemia of the brain tissues normally perfused by the damaged vessels.
· sympathetic nervous system--Part of the nervous system that accelerates heart rate, constricts blood vessels, and raises blood pressure
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