Fitzgerald Kevin T, Bronstein Alvin C
VCA Alameda East Veterinary Hospital, Denver, CO 80247 , USA.
Top Companion Anim Med. 2013 Feb;28(1):2-7. doi: 10.1053/j.tcam.2013.03.002.
The American Psychiatric Association estimates that 3-7% of US school-aged children exhibit attention-deficit/hyperactivity disorder (ADHD). Adderall(®) (amphetamine dextroamphetamine) and a variety of brand names and generic versions of this combination are available by prescription to treat ADHD and narcolepsy. Both immediate and sustained release products are used as are single agent amphetamine medication. Knowing the exact agent ingested can provide information of dose labeled and length of clinical effects. These drugs are used off label by college students for memory enhancement, test taking ability, and for study marathons. These agents are DEA Schedule II controlled substances with high potential for abuse. For humans with ADHD or narcolepsy, standard recommended dosage is 5-60 mg daily. Amphetamine and its analogues stimulate the release of norepinephrine affecting both α- and β-adrenergic receptor sites. α-Adrenergic stimulation causes vasoconstriction and an increase in total peripheral resistance. β-Adrenergic receptor stimulation leads to an increase in heart rate, stroke volume, and skeletal muscle blood flow. Clinical signs of Adderall(®) overdose in humans and dogs include hyperactivity, hyperthermia, tachycardia, tachypnea, mydriasis, tremors, and seizures. In addition, Adderall intoxication in dogs has been reported to cause hyperthermia, hypoglycemia, hypersegmentation of neutrophils, and mild thrombocytopenia. Diagnosis can be confirmed by detecting amphetamine in stomach contents or vomitus, or by positive results obtained in urine tests for illicit drugs. Treatment is directed at controlling life-threatening central nervous system and cardiovascular signs. Seizures can be controlled with benzodiazepines, phenothiazines, pentobarbital, and propofol. Cardiac tachyarrhythmias can be managed with a β-blocker such as propranolol. Intravenous fluids counter the hyperthermia, assist in maintenance of renal function, and help promote the elimination of amphetamine and its analogues. Prognosis after poisoning with Adderall(®) depends upon the severity and duration of clinical signs at presentation. Differential diagnoses that should be considered in cases of suspected amphetamine overdose are any other agents that can cause central nervous system stimulation, tremors, and seizures. This article discusses our present understanding of Adderall(®) intoxication and examines 3 dogs presented to our practice after ingestion of large amounts of the drug.
美国精神病学协会估计，3%至7%的美国学龄儿童患有注意力缺陷多动障碍（ADHD）。阿得拉（Adderall®）（苯丙胺右旋苯丙胺）以及该复方制剂的多种品牌名和通用版本可凭处方用于治疗ADHD和发作性睡病。速释和缓释产品均有使用，单剂苯丙胺药物也同样如此。了解确切摄入的药物制剂可提供标签标注剂量及临床效应持续时间的信息。大学生会超适应症使用这些药物来增强记忆力、提高应试能力以及进行长时间学习。这些药物属于美国药品管理局（DEA）管制的二类精神药品，具有很高的滥用可能性。对于患有ADHD或发作性睡病的人，标准推荐剂量为每日5至60毫克。苯丙胺及其类似物刺激去甲肾上腺素的释放，作用于α和β肾上腺素能受体位点。α肾上腺素能刺激导致血管收缩以及总外周阻力增加。β肾上腺素能受体刺激导致心率、每搏输出量和骨骼肌血流量增加。人类和犬类阿得拉（Adderall®）过量的临床体征包括多动、体温过高、心动过速、呼吸急促、瞳孔散大、震颤和癫痫发作。此外，据报道犬类阿得拉中毒会导致体温过高、低血糖、中性粒细胞核分叶过多以及轻度血小板减少。通过检测胃内容物或呕吐物中的苯丙胺，或通过非法药物尿液检测的阳性结果可确诊。治疗旨在控制危及生命的中枢神经系统和心血管体征。癫痫发作可用苯二氮䓬类、吩噻嗪类、戊巴比妥和丙泊酚控制。心脏快速性心律失常可用β受体阻滞剂如普萘洛尔处理。静脉输液可对抗体温过高，有助于维持肾功能，并促进苯丙胺及其类似物的排泄。阿得拉（Adderall®）中毒后的预后取决于就诊时临床体征的严重程度和持续时间。疑似苯丙胺过量病例应考虑的鉴别诊断包括任何其他可导致中枢神经系统刺激、震颤和癫痫发作的药物。本文讨论了我们目前对阿得拉（Adderall®）中毒情况的认识，并研究了3只因摄入大量该药物而前来我们诊所就诊的犬。
