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Clinical features

  • tend to be admitted from party, concert or rave
  • CNS features: agitation, coma, convulsions, muscle rigidity, hyperthermia, sweating, dilated pupils, panic, paranoia, trismus, bruxism (grinding of teeth), intracranial infarction and thrombosis, intracranial haemorrhage, cerebral oedema
  • CVS: tachycardia, ventricular arrhythmias, hypertension followed by hypotension, spontaneous bleeding
  • GI: jaundice, hepatomegaly, hepatic failure
  • Renal: oliguria, myoglobinuria due to rhabdomyolysis
  • Biochemistry: metabolic acidosis, hypoglycaemia, raised creatinine, K, CPK, LFTs, hyponatraemia
  • DIC
  • fulminant syndrome can develop within hours so close observation is necessary


  • supportive care with attention to airway, breathing and circulation
  • consider ICU admission in all but the mildest cases
  • empty stomach and give activated charcoal
  • agitation and fits: incremental doses of diazepam
  • hyperthermia: needs to be treated urgently using cooling blankets, ice-packs, infusion of cold saline and peritoneal dialysis using cold dialysate. Consider using dantrolene: very successful in one (small) series. 1 mg/kg IV repeated to a total dose of 10 mg/kg
  • prophylaxis of acute renal failure from rhabdomyolysis. Take care not to precipitate pulmonary oedema or worsen cerebral oedema with excessive fluid loading

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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