9.2.2 Inhalation
As for 9.2.1.
9.2.3 Skin exposure
No relevant data.
9.2.4 Eye contact
No relevant data.
9.2.5 Parenteral exposure
As for 9.2.1.
9.2.6 Other
Vaginal exposure, as for 9.2.1.
9.3 Course, prognosis, cause of death
Symptoms and signs give a clinical guide to the severity
of intoxication as follows (Espelin and Done, 1968):
Mild toxicity - restlessness, irritability, insomnia, tremor,
hyperreflexia, sweating, dilated pupils, flushing;
Moderate toxicity - hyperactivity, confusion, hypertension,
tachypnoea, tachycardia, mild fever, sweating;
Severe toxicity - delirium, mania, self-injury, marked
hypertension, tachycardia, arrhythmia, hyperpyrexia,
convulsion, coma, circulatory collapse.
Death can be due to intracranial haemorrhage, acute heart
failure or arrhythmia, hyperpyrexia, rhabdomyolysis and
consequent hyperkalaemia or renal failure, and to violence
related to the psychiatric effects (Kalant & Kalant, 1975).
9.4 Systematic description of clinical effects
9.4.1 Cardiovascular
Cardiovascular symptoms of acute poisoning
include palpitation and chest pain. Tachycardia and
hypertension are common. One third of patients
reported by Derlet et al. (1989) had a blood pressure
greater than 140/90 mmHg, and nearly two-thirds had a
pulse rate above 100 beats per minute.
Severe poisoning can cause acute myocardial ischaemia,
myocardial infarction (Carson et al., 1987; Packe et
al., 1990), and left ventricular failure (Kalant &
Kalant, 1975). These probably result from vasospasm,
perhaps at sites of existing atherosclerosis. In at
least one case, thrombus was demonstrated initially
(Bashour, 1994).
Chronic oral amphetamine abuse can cause a chronic
cardiomyopathy; an acute cardiomyopathy has also been
described (Call et al., 1982).
Hypertensive stroke is a well-recognised complication
of amphetamine poisoning (see 9.4.3).
Intra-arterial injection of amphetamine can cause
severe burning pain, vasospasm, and gangrene (Birkhahn
& Heifetz, 1973).
