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07-11-11 What rocks you like a hurricane?

Question of the Week
July 11, 2011
What rocks you like a hurricane?
According to Old Crow Medicine Show, Meth-am-phet-a-mine.
There has been a recent resurgence of meth labs discovered in eastern Tennessee which offers a good time to revisit the issue of methamphetamine and children found in the home of methamphetamine labs.
Known as the poor man’s cocaine, methamphetamine is a psychostimulant which stimulates release of the neurotransmitter dopamine into the neuronal synapse in the mesolimbic area of the brain.  Most drugs of abuse cause the release of dopamine.  The concentration of synaptic dopamine correlates with the “high” one feels i.e., the greater the synaptic dopamine concentration, the greater the “high”.   Activities which make you feel good, such as playing an instrument or running or a sport, also cause the release of dopamine.  However, only drugs of abuse cause so much release of dopamine that the synapse contains supraphysiologic concentrations of dopamine.  No wonder one feels good.
Methamphetamine also interacts with transporters of serotonin, NMDA, and monoamines, affecting synaptic concentrations as well as neurotransmission.
Clinically, symptoms of methamphetamine are primarily from the effects on the cardiovascular and nervous systems.  Seizures, hypertension, altered mental status, tachycardia, hyperthermia, myocardial ischemia and intracerebral hemorrhage may be seen in overdose.   Treatment is supportive with lots of benzodiazepines and paying special attention to hyperthermia. 
The following is copied from an earlier Question of the week regarding initial evaluation of children living in homes with methamphetamine labs.  A poster that was sent to all the EDs in the state is also attached.
The most common poisons found in methamphetamine production sites include solvents, ephedrine, acids, iodine, lye, phosphorus, and salt.
The dangers from living in a home that houses a methamphetamine lab include:
1)  injury or death from fire or explosions from flammable materials used in the lab
2)  poisoning from accidental ingestion or absorption of accessible chemicals
3)  upper respiratory symptoms, headaches, rashes from exposure to chemicals in the environment (inhalation , skin contact)
4)  chemical burns
5)  long term health effects, such as asthma, neurologic problems
6)  nutrition
7)  emotional or physical neglect
Questions regarding a child found in the home producing methamphetamine are the need for decontamination and the need for an immediate evaluation by a health care provider.
If there is residue on the clothes of an asymptomatic child, clothing can be changed prior to transfer.  Alternatively, the children can be given something disposable to sit on (newspaper, diaper) and then change clothes later on if need be.  The children should take a shower at some time, but do not need to be decontaminated at the scene.  Take the least traumatic approach.  Do not take toys or any materials from the house.
Initial Evaluation
Need for immediate evaluation by a health care provider can be determined by assessing if the child is asymptomatic or symptomatic. 
·          Asymptomatic
Asymptomatic children do not need to be immediately evaluated by a physician. If the paramedic or policeman finds a child that is completely asymptomatic, there is no need to take that child to the emergency department (ED). If there is a requirement for the child to be evaluated by a physician before the child can be placed in the appropriate social setting, then ED evaluation requires only a history and physical exam.
Children can subsequently be followed-up at their pediatrician’s office where issues such as neglect can be addressed. 
·          Symptomatic
For the symptomatic child, the workup should include a physical exam and history.  The laboratory testing should be based on PE findings or concerning symptoms.  A medical toxicologist is always available by calling Tennessee Poison Center. Either Dr. Williams or I will discuss specific aspects of the case.
Although there are concerns about the long-term effects of these exposures, there is not an initial evaluation or intervention that can identify or change the long-term outcome.
This question prepared by: Donna Seger, MD  Medical Toxicologist