Ver el código de «Synthetic cathinone toxicity»

==Background==
[[File:Cathinone 100.png|thumb|Chemical structure of cathinone<ref>National Center for Biotechnology Information. PubChem Compound Summary for CID 62258, Cathinone. https://pubchem.ncbi.nlm.nih.gov/compound/Cathinone. Accessed Nov. 26, 2020.</ref>]]
*Cathinone is naturally occurring β-ketone analog of amphetamine found in the leaves of the “khat” plant (Catha edulis) consumed recreationally in Arabian peninsula and northeast Africa
*Methcathinone first synthesized in 1928
*Sharp increase in exposures around 2007-2011 due to products sold as “bath salts” and labelled “not for human consumption”
*Common synthetic versions found today include mephedrone, methylone, MDPV, and many others
*[[Bupropion]] is only cathinone derivative used medically in the US and Europe

===Mechanism of Action===
*Thought to be similar to MOA of amphetamines and MDMA (increase of NE, dopamine and serotonin concentrations in synapses)
**Inhibition of monoamine uptake transporters
**Release of neurotransmitters from intracellular stores
*Beta-ketone group decreases ability to penetrate BBB

{{Sympathomimetic types}}

==Clinical Features==
[[File:Qat man.jpg|thumb|Man chewing khat (Yemen).]]
*Presents similar to other [[sympathomimetics]]
*Patient experiences euphoria, increased energy, agitation, [[psychosis]], [[hallucinations]]
*Case reports suggest tachycardia tends to be more severe than hypertension (HR >150 and SBP<150)
*Can lead to psychosis, agitated delirium, [[seizures]], [[hyperthermia]], [[rhabdo]], cardiovascular collapse, [[renal failure]], hepatic dysfunction, [[DIC]] and [[death]]
**Retrospective review showed OR of 3.09 and 7.98 for rhabdomyolysis and severe rhabdomyolysis compared to other sympathomimetics

==Differential Diagnosis==
==Differential Diagnosis==
*[[Sympathomimetic toxicity]]
**Red, dry skin and absent bowel sounds favors anticholinergic toxicity
*[[Encephalitis]]
*[[Head trauma]]
*ETOH/sedative withdrawal
*[[Neuroleptic Malignant Syndrome (NMS)]]
*Acute psychotic disorder

{{Toxidrome Chart}}

{{AMS and fever DDX}}

{{Anticholinergic Toxicity Treatement}}

==Evaluation==
===Workup===
*[[EKG]], CBC, CMP, PT/INR, CK, APAP, ASA, ethanol

===Diagnosis===
*Urine drug screen does not detect synthetic cathinones; must use GCMS

==Management==
*In general, care is supportive
*[[IVF]] for dehydration/[[rhabdo]]/[[AKI]]
*[[Benzodiazepines]] for agitation

==Disposition==
*If persistently altered, admission for observation
*Otherwise if workup unremarkable and patient alert and oriented, discharge

==References==
#Prosser JM, Nelson LS. The toxicology of bath salts: a review of synthetic cathinones. J Med Toxicol. 2012;8(1):33-42. doi:10.1007/s13181-011-0193-z
#Baumann MH, Partilla JS, Lehner KR. Psychoactive "bath salts": not so soothing. Eur J Pharmacol. 2013 Jan 5;698(1-3):1-5. doi: 10.1016/j.ejphar.2012.11.020. Epub 2012 Nov 23. PMID: 23178799; PMCID: PMC3537229.
#O’Connor AD, Padilla-Jones A, Gerkin RD, Levine M. Prevalence of rhabdomyolysis in sympathomimetic toxicity: a comparison of stimulants. J Med Toxicol 2015 Jun;11(2):195-200.

[[Category:Toxicology]]