title: Acute Methylenedioxypyrovalerone Toxicity.
abstract: 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.
authors.affiliation: Departments of Pediatrics and Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA, bfroberg@iupui.edu.
authors.forename: Blake A
authors.initials: BA
authors.lastname: Froberg
authors.forename: Michael
authors.initials: M
authors.lastname: Levine
authors.forename: Michael C
authors.initials: MC
authors.lastname: Beuhler
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Judge
authors.forename: Philip W
authors.initials: PW
authors.lastname: Moore
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Engebretsen
authors.forename: Nathanael J
authors.initials: NJ
authors.lastname: Mckeown
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Rosenbaum
authors.forename: Amy C
authors.initials: AC
authors.lastname: Young
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Rusyniak
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000470:Alkaloids / Q000506:poisoning*; D052117:Benzodioxoles / Q000506:poisoning*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D013287:Illicit Drugs; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000523:psychology; D011759:Pyrrolidines / Q000506:poisoning*; D012042:Registries; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult; D000094982:Synthetic Cathinone
chemical_list: D000470:Alkaloids; D052117:Benzodioxoles; D006993:Hypnotics and Sedatives; D013287:Illicit Drugs; D011759:Pyrrolidines; C023665:cathinone; D008140:Lorazepam; D000094982:Synthetic Cathinone