Effects of methamphetamine on trauma patients: A cause of severe metabolic acidosis?

Objective: Presentation of a trauma patient with severe unexplained metabolic acidosis, possibly attributable to the vasoconstrictive properties of smokable "crystal" methamphetamine. In addition, a review of trauma registry data was undertaken to determine the effects of methamphetamine on trauma patients. Design: Case report and retrospective case-control study. Setting: Urban tertiary teaching hospital. Patients: Two controls were obtained for each case controlling for age, Injury Severity Score, and mechanism of injury. Patients greater than or equal to 16 yrs of age with a urine toxicology screen positive for methamphetamine were included. Measurements and Main Results: Data were obtained from the trauma registry for the period of January 1994 to June 1995. Trauma patients using methamphetamine had a significantly lower blood alcohol level compared with the control group. Otherwise, there were no significant differences detected in vital signs, laboratory values, procedures, treatment, or outcome between the two groups. Details regarding one patient who presented with severe life-threatening acidosis are presented. Conclusions: Trauma patients with recent use of smokable methamphetamine may present with severe acidosis requiring urgent attention and treatment. This acidosis may exaggerate the severity of the actual injury. However, urine testing for methamphetamine does not identify patients who may harbor this acidosis.