Methamphetamine is primarily metabolized in the liver and excreted by the kidneys. The kidney is most commonly affected by methamphetamine use. In 2020, Isoardi et al. looked at patients with self reports drug use and found of the 595 patients presenting to the emergency department:
Methamphetamine overdose commonly causes renal dysfunction and can cause multisystem organ failure.
Pillai et al. (2019) case report discussed a 27-year-old male that ingested approximately 1.5 grams of methamphetamine. When he arrived in the ED, he had a Glasgow coma scale (GCS) score of 3T and was reported to have a heart rate of 200/min is sinus tachycardia on the monitor. His respirations at 40/min, and he was hypotensive -systolic blood pressure in the 60s. His muscles were rigid, and his core body temperature was 42.2 °C (108 °F).
The patient’s urine was positive for meth and experienced respiratory acidosis, hyperkalemia, AKI, and elevated CK levels. The patient experienced hypotension, hyperthermia, and rhabdomyolysis, eventually progressing to disseminated intravascular coagulation and multiorgan failure. The patient died in the ICU after hours of supportive care.
The effects of methamphetamine on the kidneys can be divided into three sub-groups: vascular effects, nontraumatic rhabdomyolysis, and direct nephrotoxicity
Vascular effects, methamphetamine indirectly increases blood pressure by constriction of blood vessels. Amphetamine and methamphetamine vasoconstriction induced ischemia and hypoxia can prompt progressive necrotizing vasculitis in different organs, including renal and gastrointestinal systems (Godrati, 2020).
Nontraumatic rhabdomyolysis caused by the myotoxic effects of methamphetamine results in increased level of plasma myoglobin. Released myoglobin damages and reduces the function of filtration in kidneys resulting in acute kidney injury or renal failure.
In addition, secretion of myoglobin causes increase concentrations of plasma ET-1. It is concluded that E-1is at least partially, contributing to the significant tubular cell injury detected in myoglobinuric nephropathy (Karam, 1995).
References
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