Intoxication delirium following use of synthetic cathinone derivatives.

BACKGROUND: In published reports of hallucinatory delirium following use of "bath salts" analytic laboratory testing has demonstrated the synthetic cathinone derivative methylenedioxypyrovalerone (MDPV). MDPV can cause a false-positive screening immunoassay result for phencyclidine (PCP). Patients using MDPV are prone to development of the syndrome of excited delirium (ExD), a condition also described with PCP. OBJECTIVE: This review summarize reports from several series of cases of delirium associated with MDPV emphasizing the features of both intoxication and excited delirium. METHODS: Literature review and clinical description of a series of patients from Eastern North Carolina. CONCLUSION: MDPV is likely the responsible agent in production of both toxic and excited delirium syndromes identified with the recreational use of "bath salts" in the United States over the past two years. SCIENTIFIC SIGNIFICANCE: Patients using MDPV are prone to the development of toxic delirum with some developing ExD. a condition associated with considerable risk for serious medical morbidity. Commonly used interventions directed at extreme agitation and paranoia may exacerbate the pathophysiology of ExD.

Excited delirium following use of synthetic cathinones (bath salts).

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.