Multiorgan failure after injection of “bath salts” (MDPV)

March 19, 2012, 10:05 pm

★★★½☆

Hyperthermia and Multiorgan Failure After Abuse of “Bath Salts” Containing 3,4-Methylenedioxypyrovalerone. Borek HA, Holstege CP. Ann Emerg Med 2012 Mar 2 [Epub ahead of print]

Abstract

This case report, from the University of Virginia School of Medicine, describes a 25-year-old man who presented to the emergency department with agitation and altered mental status after injecting a “bath salt” product. On arrival he had significant tachycardia (175 bpm) and hyperthermia (106.3oF). He was also combative and had mydriasis. The patient was intubated and cooled with ice packs and cooling blankets.

During his first 2 days in the intensive care unit, the patient developed anuric renal failure requiring dialysis, hepatic failure, disseminated intravascular coagulation (DIC), and rhabdomyolysis.

Urine tested positive for the synthetic cathinone MDPV but was negative for a large number of other hallucinogens, including LSD, mescaline, MDMA (ecstasy), PCP, and psilocin.

The patient was discharged after an 18-day hospital stay, and required hemodialysis for a total of 1 month after exposure.

The authors note that MDPV inhibits re-uptake of dopamine and norepinephrine, but has little effect on serotonin activity. Although little clinical information about this hallucinogen is available, it seems to cause my psychosis and aggression than other stimulants. Treatment includes, supportive care, sedation with benzodiazepines, aggressive cooling, volume support, and monitoring for renal and hepatic failure, rhabdomyolysis, and coagulation abnormalities. As was the case with this patient, common findings on presentation, include tachycardia, hypertension, hyperthermia, mydriasis, and extreme agitation.

Related posts:

Death from MDPV-associated excited delirium

Toxicology of Synthetic Cathinones

The science of designer drugs: essential review

4 Comments:

  1. Adam Glass Says:

    I don’t believe “hallucinogen” is the best drug class to put MDPV in. Its pharmacology makes it pretty much entirely a stimulant.

    Love your blog.

  2. Leon Says:

    Adam:

    I agree that MDPV is primarily a stimulant. Unlike most hallucinogens, it has little effect on serotonin. However, anecdotal descriptions and case reports suggest that MDPV does cause some hallucinogenic activity. A DEA fact sheet makes this same point.

  3. tim Says:

    Leon:

    I disagree that MDPV directly causes hallucinogenic activity in the same vein as compounds such as LSD or psilocybin.

    Instead, it appears that psychosis manifests itself after extended usage of this compound (D2 mediated?). This psychosis includes visual hallucinations and paranoia, but appears to be unique in relation to the classical psychedelics.

  4. Leon Says:

    Tim:

    Thanks for the comment. I agree that MDPV is clearly different than the common hallucinogens that work through the serotonin system. Since MDPV has little effect on serotonin, any hallucinations that follow its use must be caused by a different mechanism.