RESUMEN
N-ethyl pentylone (ephylone) has been identified as the most recent novel stimulant to emerge into the arena of evolving novel psychoactive substances (NPS). Due to its novelty, information regarding case reports with associated quantitative confirmations, biotransformation pathways, and identified unique metabolites will assist the scientific community in understanding the implications of the emergence and risks associated with N-ethyl pentylone use. Authentic blood specimens (n = 26) submitted as part of toxicological death investigations or drugged driving casework tested positive for N-ethyl pentylone, and were quantitatively analyzed by liquid chromatography tandem mass spectrometry (LC-MS-MS). N-ethyl pentylone concentrations ranged from 12 to 1,200 ng/mL, with mean (±standard deviation) and median concentrations of 313 (±366) and 125 ng/mL, respectively, excluding one case measured at 50,000 ng/mL. N-ethyl pentylone was often found in combination with other drugs of abuse and NPS, include a variety of novel opioids including fentanyl analogs. Oral fluid specimens (n = 5), collected from recreational drug users at a dance music festival, were quantitatively analyzed using LC-MS-MS. Concentrations ranged from 12.6 to 1,377 ng/mL. Additional analysis was performed to characterize the metabolic profile of N-ethyl pentylone using human liver microsomes (HLM), followed by confirmation of the presence of the proposed metabolites in a subset of the blood specimens and oral fluid specimens. Metabolomic analysis was performed using a liquid chromatograph quadrupole time-of-flight mass spectrometer (LC-QTOF), followed by data processing using MetabolitePilot™ software. In vivo verification of in vitro HLM-generated metabolites resulted in the confirmation of four metabolites. Reduction of the beta-ketone to an alcohol resulted in the most prominent metabolite found in the authentic specimens, and its uniqueness to N-ethyl pentylone leads to this metabolite being an appropriate biomarker to determine N-ethyl pentylone ingestion. This is the first study to report N-ethyl pentylone concentrations and to characterize the metabolic profile of N-ethyl pentylone.
Asunto(s)
Benzodioxoles/sangre , Butilaminas/sangre , Cromatografía Liquida/métodos , Toxicología Forense/métodos , Metabolómica/métodos , Psicotrópicos/sangre , Saliva/metabolismo , Detección de Abuso de Sustancias/métodos , Espectrometría de Masas en Tándem , Adulto , Benzodioxoles/envenenamiento , Biotransformación , Butilaminas/envenenamiento , Causas de Muerte , Sobredosis de Droga/sangre , Sobredosis de Droga/diagnóstico , Femenino , Humanos , Masculino , Microsomas Hepáticos/metabolismo , Persona de Mediana Edad , Psicotrópicos/envenenamiento , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
CONTEXT: An increasing number of new psychoactive substances (NPS) of different chemical classes have become available through marketing and sale over the Internet. This report from the Swedish STRIDA project presents the prevalence, laboratory results, and clinical features in intoxications involving 11 stimulant pyrovalerone NPS derivatives over a 5-year period. STUDY DESIGN: Case series of consecutive patients with admitted or suspected intake of NPS presenting to Swedish hospitals for emergency treatment from January 2011 to March 2016. PATIENTS AND METHOD: Blood and urine samples were collected from intoxicated patients presenting to hospitals all over Sweden. Analyses of NPS and other drugs of abuse were performed by immunochemical and liquid chromatography-mass spectrometry multi-component methods. Clinical data were collected during consultation with the Swedish Poisons Information Centre (PIC), and retrieved from medical records. The study involved analytically confirmed cases with 11 pyrovalerone drugs. RESULTS: During the study period, 114 intoxications were detected that involved any of 11 new pyrovalerone drugs. In addition to these new pyrovalerone derivatives, 3,4-methylenedioxypyrovalerone (MDPV) was detected in 17 of the cases and α-pyrrolidinovalerophenone (α-PVP) in 45 cases. Identification was made according to forensic standards and comprised the following substances: 4F-α-PVP, α-PHP, PV8, 4Me-PPP, α-PBP, 4F-PV8, α-PPP, MDPHP, α-PVT, 4Cl-α-PVP, and 4F-α-PHP. The three most frequently detected drugs were α-PBP, MDPHP, and 4F-α-PVP. The age range of patients was 16-66 (median 30) years and 84% were males. The substance concentrations in urine and serum were highly variable, ranging from 1 ng/mL to 300 µg/mL. Poly-drug use was common with only 8 of 114 cases (7%) involving one pyrovalerone drug. The additional substances comprised other NPS and classical psychoactive drugs. The patients showed a variety of clinical signs; agitation, delirium, hallucinations, excessive motor activity, seizures, tachycardia, hypertension, and/or hyperthermia. CONCLUSIONS: In analytically confirmed NPS-related intoxications, 11 new pyrovalerone derivatives in addition to MDPV and α-PVP were found. The clinical features were consistent with a sympathomimetic toxidrome, but the urine and serum concentrations were highly variable. The results demonstrated that many novel pyrovalerone stimulants were introduced on the recreational NPS drugs market. Analytical investigations were necessary to obtain this information.
Asunto(s)
Benzodioxoles/envenenamiento , Estimulantes del Sistema Nervioso Central/envenenamiento , Pirrolidinas/envenenamiento , Adolescente , Adulto , Anciano , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Suecia/epidemiología , Adulto Joven , Cathinona SintéticaRESUMEN
Methylenedioxypyrovalerone (MDPV) is a synthetic, cathinone-derivative, central nervous system stimulant taken to produce a cocaine- or methamphetamine-like high. Physical manifestations include tachycardia, hypertension, arrhythmias, hyperthermia, sweating, rhabdomyolysis, hyperkalaemia, disseminated intravascular coagulation, oliguria and seizures. We report a patient who presented with severe metabolic acidosis, multi-organ dysfunction, rhabdomyolysis, hyperkalaemia and seizures. This case highlights that even though a urine drug screen for routine psychostimulant drugs is negative, clinicians need to be vigilant about the adverse effects of MDPV as a possible cause of multi-organ dysfunction. Substances such as this can only be detected by special tests, such as gas/liquid chromatography mass spectrometry. This is the first reported case of MDPV toxicity successfully treated in Australia to the best of our knowledge.
Asunto(s)
Benzodioxoles/envenenamiento , Estimulantes del Sistema Nervioso Central/envenenamiento , Drogas de Diseño/envenenamiento , Insuficiencia Multiorgánica/inducido químicamente , Insuficiencia Multiorgánica/terapia , Pirrolidinas/envenenamiento , Adulto , Alcaloides/agonistas , Australia , Fiebre/inducido químicamente , Cromatografía de Gases y Espectrometría de Masas , Humanos , Masculino , Terapia de Reemplazo Renal , Rabdomiólisis/inducido químicamente , Cathinona SintéticaRESUMEN
This is a case report of a fatal intoxication in Cyprus related to 3,4-methylenedioxypyrovalerone (MDPV) and 2-(methylamino)-1-phenylpentan-1-one (pentedrone) intake combined with antipsychotic and antidepressant substances. A 42- year old man with a history of serious psychiatric illness was found unresponsive in his bed. Seized materials were also found close to his body. The forensic autopsy reported myocardial infarction due to multidrug intoxication. Toxicology screening in blood and urine was applied. Biological specimens were analysed by enzyme immunoassay procedure and GC/MS. MDPV, pentedrone and etizolam detected and quantitated in blood and urine. Other drugs quantitated in blood were also olanzapine, mirtazapine, and ephedrine. This was the first fatal case reported in Cyprus associated with new psychoactive substances. Additionally, this was the first case reported to Early Warning System of the European Monitoring Center of Drugs and Drug Abuse (EMCDDA), related to multidrug intoxication, attributed to the consumption of cathinones, designer benzodiazepines, and other drugs.
Asunto(s)
Intoxicación/diagnóstico , Adulto , Antidepresivos/sangre , Antidepresivos/envenenamiento , Antipsicóticos/sangre , Antipsicóticos/envenenamiento , Benzodioxoles/sangre , Benzodioxoles/envenenamiento , Chipre , Resultado Fatal , Toxicología Forense , Humanos , Masculino , Metilaminas/sangre , Metilaminas/envenenamiento , Pentanonas/sangre , Pentanonas/envenenamiento , Intoxicación/sangre , Pirrolidinas/sangre , Pirrolidinas/envenenamiento , Cathinona SintéticaRESUMEN
BACKGROUND: "Bath salts" or synthetic cathinone toxicity remains a potentially deadly clinical condition. We report a delayed leukoencephalopathy with persistent minimally conscious state. METHODS: Case report. RESULTS: A 36-year-old man presents with delayed encephalopathy, dysautonomia, fulminant hepatic failure, and renal failure from severe rhabdomyolysis after consuming bath salts. MRI showed diffusion restriction in the splenium of the corpus callosum and subcortical white matter. CONCLUSIONS: The combination of acute leukoencephalopathy, rhabdomyolysis and fulminant hepatic failure may point to bath salt inhalation and should be known to neurointensivists.
Asunto(s)
Alcaloides/envenenamiento , Benzodioxoles/envenenamiento , Cosméticos/envenenamiento , Leucoencefalopatías/inducido químicamente , Fallo Hepático/inducido químicamente , Estado Vegetativo Persistente/inducido químicamente , Pirrolidinas/envenenamiento , Insuficiencia Renal/inducido químicamente , Adulto , Humanos , Masculino , Rabdomiólisis/inducido químicamente , Cathinona SintéticaRESUMEN
CONTEXT: In the recent years, there have been an increasing number of new psychoactive substances (NPS) available through marketing and sale on the Internet. The stimulant 3,4-methylenedioxypyrovalerone (MDPV) is a potent dopamine reuptake inhibitor, which can cause serious intoxications requiring intensive care and even fatality. This report from the STRIDA project presents the prevalence, laboratory results, and clinical features in a series of intoxications involving MDPV over a 5-year period. STUDY DESIGN: Observational case series of consecutive patients with admitted or suspected intake of NPS presented at hospitals in Sweden from 2010 to 2014. PATIENTS AND METHODS: Blood and/or urine samples were collected from intoxicated patients with admitted or suspected intake of NPS presenting at hospitals over the country. Analysis of NPS was performed by a liquid chromatography-tandem mass spectrometry multicomponent method. Clinical data were collected when caregivers consulted the Swedish Poisons Information Centre and also retrieved from medical records. The severity of poisoning was graded retrospectively using the poisoning severity score. RESULTS: During the 5-year study period, the number of MDPV-related inquiries to the Poisons Information Centre was 662 out of a total â¼4500 suspected NPS-related inquiries (â¼15%), and 201 analytically confirmed MDPV intoxications were enrolled in the study. The study period covered the period when the use of MDPV in Sweden was at its peak and also the decline to an almost zero level. The age range of patients was 18-68 (mean 36, median 35) years, and 71% were males. The MDPV concentrations in serum ranged between 1.0 ng/mL and 1509 ng/mL (mean 63.6, median 20) and between 1.0 ng/mL and 81 000 ng/mL (mean 3880, median 1160) in urine. The urinary values were also creatinine corrected for variation in urine dilution, and the MDPV/creatinine ratio ranged between 0.10 ng/mmol and 2480 ng/mmol (mean 247, median 92.6). There was a statistically significant association between the serum MDPV concentration and the urinary MDPV/creatinine ratio, for 118 cases where both data were available (r = 0.764; p < 0.0001, Spearman's rank correlation). In 30 (15%) cases, MDPV was the single psychoactive substance identified in the serum or urine specimens. In the other 171 cases, other psychoactive substances were detected together with MDPV. The additional substances (n = 61) comprised of both conventional drugs of abuse, other NPS (n = 39), pharmaceuticals, and ethanol. The cathinone-derivative alpha-pyrrolidinovalerophenone (α-PVP) was the most frequent other NPS, and was detected in 58 (29%) cases, followed by methylone in 14 (7%) cases. The main clinical manifestations reported in patients testing positive for MDPV included agitation, tachycardia (≥100/min), and hypertension (systolic blood pressure ≥140 mmHg), which were observed in 130 (67%), 106 (56%), and 65 (34%) cases, respectively. Other symptoms included hallucinations (n = 31, 16%), delirium (n = 29, 15%), hyperthermia (>39°C/102.4°F; n = 18, 10%), and rhabdomyolysis (n = 16, 8%). In MDPV intoxications with serum levels >100 ng/mL, the cases were graded as more severe and hyperthermia was less common. CONCLUSIONS: In a large number of analytically confirmed MDPV intoxications from mostly polydrug users, the urine and serum MDPV concentrations showed a high variability. The clinical features were consistent with a severe sympathomimetic toxidrome. The results also demonstrated that MDPV prevailed as a drug of abuse for a long time, after its classification as a narcotic substance and despite a high incidence of severe poisonings.
Asunto(s)
Benzodioxoles/envenenamiento , Inhibidores de Captación de Dopamina/envenenamiento , Psicotrópicos/envenenamiento , Pirrolidinas/envenenamiento , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Anciano , Benzodioxoles/sangre , Benzodioxoles/orina , Biomarcadores/sangre , Biomarcadores/orina , Cromatografía Liquida , Inhibidores de Captación de Dopamina/sangre , Inhibidores de Captación de Dopamina/orina , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Centros de Control de Intoxicaciones , Valor Predictivo de las Pruebas , Prevalencia , Psicotrópicos/sangre , Psicotrópicos/orina , Pirrolidinas/sangre , Pirrolidinas/orina , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/fisiopatología , Trastornos Relacionados con Sustancias/terapia , Suecia/epidemiología , Espectrometría de Masas en Tándem , Factores de Tiempo , Adulto Joven , Cathinona SintéticaRESUMEN
In this study, we sought to determine what impact the banning of 3, 4- methylenedioxypyrovalerone (MDPV) had on the incidence of MDPV-positive findings and on user profiles in driving under the influence of drugs (DUID) and postmortem (PM) investigations in Finland. All MDPV-positive cases and a selection of corresponding court cases between 2009 and 2012 were examined. The median serum concentration of MDPV in DUID cases was 0.030 mg/L and in PM blood 0.12 mg/L. The number of MDPV-positive cases decreased both in DUID and PM investigations after the drug was banned. The decrease in the mean monthly numbers of MDPV-positive DUID cases was 51.1%. In court cases, MDPV was rarely mentioned until banned and frequently mentioned thereafter. Of the convicted, 37% were without a fixed abode, 98% had other charges besides that of DUID, and 13% appeared in the study material more than once. In MDPV-positive PM cases, the proportion of suicides was very high (24%). Research on new psychoactive substances is required not only to support banning decisions but more importantly to be able to provide a scientific assessment of the risks of these new substances to the public and potential users.
Asunto(s)
Benzodioxoles/sangre , Drogas de Diseño/análisis , Conducir bajo la Influencia/legislación & jurisprudencia , Drogas Ilícitas/legislación & jurisprudencia , Psicotrópicos/sangre , Pirrolidinas/sangre , Adulto , Benzodioxoles/efectos adversos , Benzodioxoles/envenenamiento , Drogas de Diseño/efectos adversos , Femenino , Finlandia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Psicotrópicos/efectos adversos , Psicotrópicos/envenenamiento , Pirrolidinas/efectos adversos , Pirrolidinas/envenenamiento , Trastornos Relacionados con Sustancias/sangre , Trastornos Relacionados con Sustancias/epidemiología , Suicidio/estadística & datos numéricos , Adulto Joven , Cathinona SintéticaRESUMEN
The objective of this study was to characterize the acute clinical effects, laboratory findings, complications, and disposition of patients presenting to the hospital after abusing synthetic cathinone. We conducted a retrospective multicenter case series of patients with synthetic cathinone abuse by searching for the terms bath salts, MDPV, methylenedioxypyrovalerone, mephedrone, methcathinone, methylone, methedrone, and cathinone within the "agent" field of a national clinical toxicology database (ToxIC). The medical records of these patients were obtained and abstracted by investigators at each study site. Patients with confirmatory testing that identified a synthetic cathinone in either blood or urine were included in the series. Patients who had either an undetectable synthetic cathinone test or no confirmatory testing were excluded. A data abstraction sheet was used to obtain information on each patient. We entered data into an Excel spreadsheet and calculated descriptive statistics. We identified 23 patients with confirmed synthetic cathinone exposure--all were positive for methylenedioxyprovalerone (MDPV). Eighty-three percent were male and 74 % had recreational intent. The most common reported clinical effects were tachycardia (74 %), agitation (65 %), and sympathomimetic syndrome (65 %). Acidosis was the most common laboratory abnormality (43 %). Seventy-eight percent of patients were treated with benzodiazepines and 30 % were intubated. Ninety-six percent of patients were hospitalized and 87 % were admitted to the ICU. The majority (61 %) of patients was discharged home but 30 % required inpatient psychiatric care. There was one death in our series. The majority of patients presenting to the hospital after abusing MDPV have severe sympathomimetic findings requiring hospitalization. A number of these patients require inpatient psychiatric care after their acute presentation.
Asunto(s)
Alcaloides/envenenamiento , Benzodioxoles/envenenamiento , Pirrolidinas/envenenamiento , Trastornos Relacionados con Sustancias/diagnóstico , Adolescente , Adulto , Factores de Edad , Diagnóstico Dual (Psiquiatría) , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Drogas Ilícitas , Lorazepam/uso terapéutico , Masculino , Persona de Mediana Edad , Agitación Psicomotora/psicología , Sistema de Registros , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Resultado del Tratamiento , Adulto Joven , Cathinona SintéticaRESUMEN
Synthetic "designer drugs" with hallucinogenic properties have become increasingly popular among recreational drug users in recent years. Some of the designer drugs are chemically modified drugs previously used in treatment of depression and chronic fatigue. The drugs are available from a large number of internet distributers. There is very little knowledge of the clinical symptoms and how intoxicated people should be treated. We present a review of published literature (including 284 intoxicated patients) and experiences from the Danish poison centre concerning two chemical derivatives of earlier registered drugs.
Asunto(s)
Alcaloides/farmacología , Benzodioxoles/farmacología , Estimulantes del Sistema Nervioso Central/farmacología , Drogas de Diseño/farmacología , Pirrolidinas/farmacología , Triptaminas/farmacología , Alcaloides/administración & dosificación , Alcaloides/envenenamiento , Benzodioxoles/administración & dosificación , Benzodioxoles/envenenamiento , Estimulantes del Sistema Nervioso Central/administración & dosificación , Estimulantes del Sistema Nervioso Central/envenenamiento , Enfermedad Crónica , Depresión/tratamiento farmacológico , Drogas de Diseño/administración & dosificación , Drogas de Diseño/envenenamiento , Fatiga/tratamiento farmacológico , Alucinógenos/administración & dosificación , Alucinógenos/farmacología , Alucinógenos/envenenamiento , Humanos , Inhibidores de la Monoaminooxidasa/administración & dosificación , Inhibidores de la Monoaminooxidasa/farmacología , Inhibidores de la Monoaminooxidasa/envenenamiento , Centros de Control de Intoxicaciones , Pirrolidinas/administración & dosificación , Pirrolidinas/envenenamiento , Triptaminas/administración & dosificación , Triptaminas/envenenamiento , Cathinona SintéticaRESUMEN
"Bath salts" is a well known street drug which can cause several cardiovascular and neuropsychiatric symptoms. However, only one case of acute kidney injury has been reported in the literature. We present a case with sympathomimetic syndrome, choreoathetosis, gustatory and olfactory hallucinations, and acute kidney injury following the use of bath salts. A 37-year-old man with past medical history of hypertension and depression was brought to the emergency center with body shaking. Three days before admission he injected 3 doses of bath salts intravenously and felt eye pain with blurry vision followed by a metallic taste, strange smells, profuse sweating, and body shaking. At presentation he had a sympathomimetic syndrome including high blood pressure, tachycardia, tachypnea, and hyperhydrosis with choreoathetotic movements. Laboratory testing revealed leukocytosis and acute kidney injury with a BUN of 95 mg/ dL and a creatinine of 15.2 mg/dL. Creatine kinase was 4,457 IU/dL. Urine drug screen is negative for amphetamine, cannabinoids, and cocaine; blood alcohol level was zero. During his ICU stay he became disoriented and agitated. Supportive treatment with 7.2 liters of intravenous fluid over 3 days, haloperidol, and lorazepam gradually improved his symptoms and his renal failure. Bath salts contain 3,4-methylenedioxypyrovalerone, a psychoactive norepinephrine and dopamine reuptake inhibitor. Choreoathetosis in this patient could be explained through dopaminergic effect of bath salts or uremic encephalopathy. The mechanism for acute kidney injury from bath salts may involve direct drug effects though norepinephrine and dopamine-induced vasoconstriction (renal ischemia), rhabdomyolysis, hyperthermia, and/or volume contraction.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Atetosis/inducido químicamente , Benzodioxoles/envenenamiento , Catecolaminas/envenenamiento , Estimulantes del Sistema Nervioso Central/envenenamiento , Corea/inducido químicamente , Metanfetamina/análogos & derivados , Pirrolidinas/envenenamiento , Adulto , Drogas de Diseño/envenenamiento , Humanos , Inyecciones , Masculino , Metanfetamina/envenenamiento , Síndrome , Cathinona SintéticaRESUMEN
3,4-Methylenedioxypyrovalerone (MDPV) is a psychoactive, synthetic analog of the central nervous system stimulant cathinone. Its recent popularity as a recreational drug in the United States has led to numerous reports to poison control centers across the country. As with other synthetic cathinones, the recreational use of MDPV has resulted in death. MDPV is thought to exert its pharmacologic effects by inhibiting the reuptake of dopamine and norepinephrine. This report describes the case of an exposure of a 39-year-old male to MDPV, which resulted in his death. Postmortem concentrations of MDPV in various tissues were measured. The detection of MDPV in tissues and fluids was accomplished using gas chromatography-mass spectrometry analysis after solid-phase extraction. Blood analysis also demonstrated therapeutic levels of lamotrigine, fluoxetine, risperidone, benztropine, pseudoephedrine and ibuprofen. The detection of cathinones in hair was conducted using high-performance liquid chromatography-tandem mass spectrometry after solid-phase extraction. MDPV was uniformly distributed among multiple tissues (blood, brain, muscle, cerebrospinal fluid and lung) at concentrations of approximately 0.4 to 0.6 µg/mL. Tissue and fluids responsible for detoxification/excretion had higher concentrations of MDPV (kidney, liver and bile > 0.8 µg/mL). A blood concentration ≥ 0.4 µg/mL was judged sufficient to cause death. The cause of death was ruled MDPV intoxication resulting in cardiac arrhythmia.
Asunto(s)
Arritmias Cardíacas/diagnóstico , Baños , Benzodioxoles/envenenamiento , Drogas de Diseño/envenenamiento , Psicotrópicos/envenenamiento , Pirrolidinas/envenenamiento , Trastornos Relacionados con Sustancias/diagnóstico , Adulto , Alcaloides/metabolismo , Arritmias Cardíacas/inducido químicamente , Autopsia , Benzodioxoles/sangre , Benzodioxoles/líquido cefalorraquídeo , Encéfalo/metabolismo , Causas de Muerte , Cromatografía Líquida de Alta Presión , Drogas de Diseño/metabolismo , Resultado Fatal , Toxicología Forense/métodos , Cromatografía de Gases y Espectrometría de Masas , Cabello/metabolismo , Humanos , Pulmón/metabolismo , Masculino , Músculo Esquelético/metabolismo , Psicotrópicos/sangre , Psicotrópicos/líquido cefalorraquídeo , Pirrolidinas/sangre , Pirrolidinas/líquido cefalorraquídeo , Extracción en Fase Sólida , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/metabolismo , Trastornos Relacionados con Sustancias/patología , Espectrometría de Masas en Tándem , Distribución Tisular , Cathinona SintéticaAsunto(s)
Benzodioxoles/envenenamiento , Drogas de Diseño/envenenamiento , Coagulación Intravascular Diseminada/inducido químicamente , Pirrolidinas/envenenamiento , Delirio/inducido químicamente , Coagulación Intravascular Diseminada/diagnóstico , Resultado Fatal , Femenino , Fiebre/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Cathinona SintéticaAsunto(s)
Benzodioxoles/envenenamiento , Drogas de Diseño/envenenamiento , Psicotrópicos/envenenamiento , Pirrolidinas/envenenamiento , Benzodioxoles/análisis , Benzodioxoles/química , Estimulantes del Sistema Nervioso Central/análisis , Estimulantes del Sistema Nervioso Central/química , Estimulantes del Sistema Nervioso Central/envenenamiento , Cromatografía Liquida , Drogas de Diseño/análisis , Drogas de Diseño/química , Servicios Médicos de Urgencia/estadística & datos numéricos , Humanos , Drogas Ilícitas/análisis , Drogas Ilícitas/química , Drogas Ilícitas/envenenamiento , Internet , Registros Médicos , Admisión del Paciente/estadística & datos numéricos , Fenetilaminas/química , Intoxicación/diagnóstico , Intoxicación/terapia , Psicotrópicos/análisis , Psicotrópicos/química , Pirrolidinas/análisis , Pirrolidinas/química , Estudios Retrospectivos , Medición de Riesgo , Suecia , Espectrometría de Masas en Tándem , Cathinona SintéticaRESUMEN
Synthetic analogs of the cathinone molecule have seen increasing recreational use as substitutes for cocaine, 3,4-methylenedioxymethamphetamine (ecstasy) and methamphetamine. Repeated use of these drugs is associated with a paranoid hallucinatory delirium. A subset of patients using these substances develops a syndrome of extreme agitation and violent behavior that has been reported following the use of other stimulant drugs that also produce rapid changes in brain monoamines. This syndrome, characterized as "excited delirium," presents to the acute care setting with a challenging combination of paranoia, severe agitation and violent behavior. These patients frequently suffer from dehydration, skeletal muscle damage and renal failure that may lead to multiorgan failure and death. Management of these individuals requires careful consideration of the consequences of interventions commonly implemented in medical settings to control dangerous aggressive behavior.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Alcaloides/envenenamiento , Benzodioxoles/envenenamiento , Estimulantes del Sistema Nervioso Central/envenenamiento , Deshidratación/inducido químicamente , Delirio/inducido químicamente , Pirrolidinas/envenenamiento , Lesión Renal Aguda/complicaciones , Adulto , Conducta Peligrosa , Deshidratación/complicaciones , Delirio/complicaciones , Humanos , Drogas Ilícitas/envenenamiento , Masculino , Insuficiencia Multiorgánica/inducido químicamente , Insuficiencia Multiorgánica/complicaciones , Conducta Paranoide/inducido químicamente , Conducta Paranoide/complicaciones , Agitación Psicomotora/complicaciones , Rabdomiólisis/inducido químicamente , Rabdomiólisis/complicaciones , Síndrome , Cathinona SintéticaRESUMEN
Abuse of the psychoactive "designer drug" methylenedioxypyrovalerone (MDPV) has become a serious international public health concern because of the severity of its physical and behavioral toxicities. MDPV is the primary ingredient in so-called "bath salts," labeled as such to avoid criminal prosecution and has only been classified recently as a controlled substance in the United States and some other countries. However, it remains a danger because of illegal sources, including the Internet. MDPV is a synthetic, cathinone-derivative, central nervous system stimulant and is taken to produce a cocaine- or methamphetamine-like high. Administered via oral ingestion, nasal insufflation, smoking, intravenous or intramuscular methods, or the rectum, the intoxication lasts 6 to 8 hours and has high addictive potential. Overdoses are characterized by profound toxicities, causing increased attention by emergency department and law enforcement personnel. Physical manifestations range from tachycardia, hypertension, arrhythmias, hyperthermia, sweating, rhabdomyolysis, and seizures to those as severe as stroke, cerebral edema, cardiorespiratory collapse, myocardial infarction, and death. Behavioral effects include panic attacks, anxiety, agitation, severe paranoia, hallucinations, psychosis, suicidal ideation, self-mutilation, and behavior that is aggressive, violent, and self-destructive. Treatment is principally supportive and focuses on counteracting the sympathetic overstimulation, including sedation with intravenous benzodiazepines, seizure-prevention measures, intravenous fluids, close (eg, intensive care unit) monitoring, and restraints to prevent harm to self or others. Clinical presentation is often complicated by coingestion of other psychoactive substances that may alter the treatment approach. Clinicians need to be especially vigilant in that MDPV is not detected by routine drug screens and overdoses can be life-threatening.
Asunto(s)
Benzodioxoles/envenenamiento , Estimulantes del Sistema Nervioso Central/envenenamiento , Drogas de Diseño/envenenamiento , Control de Medicamentos y Narcóticos , Psicotrópicos/envenenamiento , Pirrolidinas/envenenamiento , Trastornos Relacionados con Sustancias/prevención & control , Sistema Nervioso Simpático/efectos de los fármacos , Alcaloides/envenenamiento , Ansiedad/inducido químicamente , Benzodioxoles/química , Estimulantes del Sistema Nervioso Central/química , Drogas de Diseño/química , Sobredosis de Droga , Semivida , Alucinaciones/inducido químicamente , Humanos , Trastornos Paranoides/inducido químicamente , Agitación Psicomotora/etiología , Psicotrópicos/química , Pirrolidinas/química , Conducta Autodestructiva/inducido químicamente , Trastornos Relacionados con Sustancias/etiología , Sistema Nervioso Simpático/fisiopatología , Estados Unidos , Cathinona SintéticaAsunto(s)
Benzodioxoles/envenenamiento , Isquemia Encefálica/inducido químicamente , Drogas de Diseño/envenenamiento , Hemiplejía/inducido químicamente , Hemorragias Intracraneales/inducido químicamente , Psicotrópicos/envenenamiento , Pirrolidinas/envenenamiento , Accidente Cerebrovascular/inducido químicamente , Adulto , Isquemia Encefálica/patología , Humanos , Hemorragias Intracraneales/patología , Masculino , Accidente Cerebrovascular/patología , Cathinona SintéticaAsunto(s)
Alcaloides/envenenamiento , Benzodioxoles/envenenamiento , Drogas Ilícitas/envenenamiento , Metanfetamina/análogos & derivados , Pirrolidinas/envenenamiento , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/terapia , Diagnóstico Diferencial , Humanos , Metanfetamina/envenenamiento , Cathinona SintéticaRESUMEN
Synthetic legal intoxicating drugs (SLIDs), such as those commonly contained in products sold over the counter as "bath salts" and "incense," have risen tremendously in popularity in the past few years. These drugs can have powerful adverse effects, including acute psychosis with delusions, hallucinations, and potentially dangerous, bizarre behavior.
Asunto(s)
Drogas de Diseño/envenenamiento , Drogas Ilícitas/envenenamiento , Trastornos Relacionados con Sustancias/diagnóstico , Benzodioxoles/envenenamiento , Cannabinoides/envenenamiento , Estimulantes del Sistema Nervioso Central/envenenamiento , Drogas de Diseño/química , Humanos , Drogas Ilícitas/química , Metanfetamina/análogos & derivados , Metanfetamina/envenenamiento , Psicotrópicos/envenenamiento , Pirrolidinas/envenenamiento , Cathinona SintéticaRESUMEN
"Bath salts" are being increasingly used as drugs of abuse. These products have been found to contain a variety of compounds, including 3,4-methylenedioxypyrovalerone (MDPV). We present a case of a 25-year-old man who injected bath salts and acutely developed severe agitation, hyperthermia, and tachycardia. Despite aggressive early medical management, including dialysis, he progressed to multiorgan system failure, although he ultimately recovered after a prolonged hospital course. The only chemical substance detected on comprehensive toxicologic testing was MDPV, a synthetic cathinone analogue. According to our case, MDPV abuse may result in adverse multisystem organ effects, including rhabdomyolysis, cardiac injury, hepatic injury, and renal failure. It is unknown whether these end-organ effects were due to direct cellular toxicity induced by MDPV or a result of the patient's marked agitation and hyperthermia. Acute management should focus on the rapid identification of organ injury and appropriate supportive care.