Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Stimulant Use and Intoxication

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In one line

·Cocaine, meth, or MDMA flood the brain with dopamine and norepinephrine—the heart races, blood pressure spikes, body heat soars, and thinking goes off the rails.

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Normal physiology

·Normally, dopamine (the brain chemical that signals reward, motivation, and movement) and norepinephrine (the brain chemical that switches on the body's alarm and focus systems) rise and fall in a smooth, controlled rhythm. The prefrontal cortex—the front part of the brain that plans, judges risk, and pumps the brakes on impulses—keeps these chemicals in balance so you feel alert and motivated without tipping into panic or overheating.

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What goes wrong

·Stimulants (cocaine, meth, MDMA) block the pumps that normally suck dopamine and norepinephrine back into storage, and some also force the brain to dump even more—so the chemicals flood the spaces between brain cells and keep firing the alarm and reward circuits over and over without a break. The prefrontal cortex—the part that should say "stop, this is dangerous"—gets overwhelmed and goes offline, so the body's throttle is stuck wide open with no brakes.

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Hallmark signs

·Racing heartbeat (tachycardia)
·High blood pressure (hypertension)
·Wide, large pupils (mydriasis)
·Sweating and feeling too hot
·Restlessness, jitteriness, or agitation
·Chest pain
·Seizure (sudden jerking or loss of awareness)
·Confusion, paranoia, or hallucinations

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Red flags · escalate now

·Chest pain or pressure (may signal heart attack or torn aorta)
·Seizure or uncontrollable shaking
·Severe confusion, hallucinations, or violent agitation
·Temperature above 104°F (40°C) or muscle rigidity (risk of dangerous overheating)
·Sudden worst-ever headache or one-sided weakness (possible stroke or brain bleed)

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Workup

·Electrocardiogram (ECG)
·Troponin I or troponin T (cardiac biomarker)
·Creatine kinase (CK) and urine myoglobin
·Basic metabolic panel (sodium, potassium, creatinine, glucose)
·Urine drug screen (immunoassay) ± confirmatory testing (gas chromatography–mass spectrometry, GC-MS)
·Non-contrast head CT scan

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Treatment

·Benzodiazepines—lorazepam 2–4 mg IV or IM, or diazepam 5–10 mg IV, repeated every 10–15 minutes as needed
·Active cooling—remove clothing, apply ice packs to groin/armpits/neck, spray with cool water and fan, or use a cooling blanket if core temperature is above 39°C (102°F)
·IV fluids (normal saline or lactated Ringer's) at 200–500 mL/hour, aiming for urine output above 200–300 mL/hour; add sodium bicarbonate (150 mEq in 1 liter D5W) if urine is dark or myoglobin-positive
·Antipsychotic—haloperidol 5 mg IM or olanzapine 10 mg IM, only if psychosis (paranoia, hallucinations, delusions) persists after adequate benzodiazepine dosing
·Avoid beta-blockers (like metoprolol or propranolol) for high blood pressure or fast heart rate
·Contingency management (small cash or vouchers for clean urine tests) + cognitive behavioral therapy + stable housing + peer recovery support, started before discharge

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NCLEX trap

·Beta-blockers alone are dangerous here. They block the heart's pump but leave blood vessels still squeezed tight. Blood pressure can shoot even higher. Use benzodiazepines first to calm the whole nervous system—the prefrontal cortex (the brain's brakes), the amygdala (the brain's alarm center), and the brainstem (which controls heart rate and blood pressure).
·Stimulant-induced psychosis can last hours or even days because dopamine (the brain's reward and motivation messenger) stays flooded in the mesolimbic pathway (the brain's reward circuit). If the psychosis is severe enough to put the person or others at risk, an antipsychotic (like haloperidol) may be needed now, not later.
·Aggressive cooling can cause shivering, which makes the muscles work harder and produces even more heat. Cool the person slowly with room-temperature IV fluids and a cool room. Watch for rhabdomyolysis (muscle breakdown that releases protein into the blood) and give plenty of IV fluids to protect the kidneys.
·Seizures can repeat because the drug keeps the brain's excitatory system (driven by glutamate and norepinephrine) revved up. Keep benzodiazepines on hand and watch closely. The seizure risk drops as the drug leaves the body, but the window of danger can last hours.
·Stimulant intoxication requires both medical stability and social safety. The person needs a plan for substance use treatment, mental health follow-up, and housing or support. Without it, relapse and death risk are very high—especially in the first 48 hours after leaving the hospital.
·The social factors (housing, poverty, trauma, no therapy) are as dangerous as the drug itself. Stabilization means fixing both the biology (the dopamine surge, the high blood pressure) and the life situation (shelter, food, addiction counseling) at the same time. One without the other is not enough.

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