Case history
Case history #1
A 32-year-old man presents to the emergency department with a history of smoking methamphetamine. He is requesting help to stop using methamphetamine. On examination, the patient has evidence of chronic teeth grinding and multiple skin excoriations with scars on his hands and upper arms. An initial urine drug toxicology screen is positive for amphetamines. Gas chromatography and mass spectrometry analysis of the urine confirms methamphetamine. An ECG shows sinus tachycardia with evidence of left ventricular hypertrophy. He is referred to a local drug treatment program after consultation with social workers.
Case history #2
A 28-year-old man presents to his primary care practitioner complaining of depression. He has smoked, snorted, and used intravenous methamphetamine for 5 years except while in jail. He has noted increased atypical chest pain radiating to his back on minimal exercise over the past several months. He denies using any drugs in the past month. An ECG shows evidence of right ventricular strain. Assays for cardiac enzymes are negative. A urine screen is positive for amphetamines. An echocardiogram confirms right ventricular enlargement and an estimated mean pulmonary pressure of 55 mmHg. HIV and hepatitis B and C serologies are negative. The patient agrees to participate in a drug treatment program and is evaluated for medical treatment for pulmonary hypertension.
Other presentations
In cases of suspected smuggling, imaging is used to evaluate patients who may have ingested large amounts of drugs that are contained in wrappings. Metal wrappings such as aluminum foil make for easy radiographic identification, but the presence of plastic bags and condoms may be more challenging to determine radiologically.
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