Critical Care: Miscellaneous Critical Care |

Critical Illness Associated With Methamphetamine Exposure in the Central Valley of California (CRIME) FREE TO VIEW

Pradeep Doddamreddy, MD; Jakhangirkhodja Tulyagankhodjaev; Crystal Ives, MD; Patil Armenian, MD; Rais Vohra, MD; Vijay Balasubramanian, MD
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UCSF-Fresno, Fresno, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):333A. doi:10.1016/j.chest.2016.08.346
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SESSION TITLE: Miscellaneous Critical Care

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: The Stimulant Associated Disease Database (SADD) was established to document the health related consequences of methamphetamine exposure (ME) from a single tertiary care center in the Central Valley of California. This interim analysis focuses on critical illness associated with ME.

METHODS: Data was derived from SADD, an ongoing retrospective observational registry study at our institution including all patients with a positive urine drug screen (UDS) for amphetamines, which is used as a surrogate for methamphetamine positive. Of 16,232 UDS ordered from Jan to Dec 2013, 2714 were positive (16.72%). We retrospectively reviewed 688 of these medical charts with a focus on patients with critical illness.

RESULTS: Among 688 patients, 56 (8.14%) were admitted to the Intensive Care Unit (ICU). The average age was 45.28 years, and predominantly male (62.5%). 46.45% of the patients were brought to the Emergency Department (ED) for altered mental state (AMS), while 37.5% were brought for trauma. Other chief complaints included “found down” (19.64%), shortness of breath (14.29%), suicidal ideations (7.14%) and seizure (3.57%). Of note, 42.85% of the patients were hypertensive (SBP >140) upon arrival to the ED with an average blood pressure of 183/104 mmHg. Admission locations were: medical ICU (60.71%), trauma ICU (32.14%), burn ICU (5.36%), and surgical ICU (1.78%). The admitting diagnoses included AMS (16.07%), septic shock (12.5%), gunshot wound (10.7%), blunt trauma (7.14%), seizure (7.14%), cerebrovascular hemorrhage (7.14%), stab wounds (5.3%), and motor vehicle collision (5.3%). A few other included auto vs pedestrian, hypertensive emergency, acute kidney injury (AKI), train vs pedestrian, and respiratory failure. The mean ICU length of stay (LOS) of 7.84 ± 10.78 days. 67.85% required mechanical ventilatory support with an average of 6.18 ± 10.379 ventilator days (VD). 12.5% required vasopressors and coincidentally 12.5% also were bacteremic. 16.07% of the patients had AKI while 5.35% were found to have rhabdomyolysis. However, only one patient (1.78%) required dialysis. Of the 56 ICU admissions, 6 (10.71%) expired in the ICU. Majority of these patients were male (66.67%) with an average age of 47.5 years. All these patients presented with AMS and they had an average ICU LOS of 5.17 days & 4.67 VD. The causes of death included multi-organ failure, multiple cerebral infarcts, cerebral edema, brain herniation, bacterial endocarditis and septic shock.

CONCLUSIONS: 1. Amongst all UDS requested over a one year period,16.72% were positive for ME, 8% requiring ICU care. 2. ME was more predominant in young men 3. Hypertension was prevalent (>40%) upon arrival to the ED with an average SBP > 180 mmHg 4. Altered Mental State, Septic shock and Trauma accounted for > 80% of the ICU admissions with an average ICU LOS > 7 days.

CLINICAL IMPLICATIONS: Methamphetamine abuse is a serious and growing national health issue problem. Its impact on health care utilization has not been studied. Large scale population-based analyses of acute and chronic medical consequences of ME are lacking. We hope our SADD may provide more insight to help us better anticipate and manage the possible medical consequences associated with ME.

DISCLOSURE: The following authors have nothing to disclose: Pradeep Doddamreddy, Jakhangirkhodja Tulyagankhodjaev, Crystal Ives, Patil Armenian, Rais Vohra, Vijay Balasubramanian

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