Division of Medical Toxicology, Department of Emergency Medicine, University of California-San Diego, 200 W Arbor Dr #8925, San Diego, CA 92103-8925, USA.
J Med Toxicol. 2012 Sep;8(3):310-3. doi: 10.1007/s13181-012-0232-4.
The use of designer drugs commonly marketed as bath salts or plant food has risen dramatically in recent years. Several different synthetic cathinones have been indentified in these products, including mephedrone, 3,4-methylenedioxypyrovalerone (MDPV), and 4-fluoromethcathinone (flephedrone). We report a case of bath salt intoxication with quantitative MDPV and flephedrone levels in a patient's serum and urine, and from the bath salt product.
A 23-year-old male with a prior psychiatric history arrived via EMS for bizarre behavior, suicidality, and hallucinations after reportedly insufflating a bath salt. He was found to have MDPV levels of 186 and 136 ng/mL in his serum and urine, respectively, and flephedrone levels of 346 and 257 ng/mL in the serum and urine, respectively. The white powder in question was found to contain 143 μg MDPV and 142 μg flephedrone per milligram powder. His psychosis and agitation resolved with lorazepam, droperidol, and observation in the emergency department.
Agitation, psychosis, movement disorders, tachycardia, and hypertension have all been attributed to the use of MDPV; there are no prior reports detailing clinical experience with flephedrone. Considering that our patient's serum flephedrone levels were twofold higher than his MDPV level, it is likely flephedrone contributed to his clinical toxicity. This case suggests the possibility that fluorinated cathinones, such as flephedrone, may have altered metabolism and/or elimination which may affect their course of clinical toxicity. This case highlights the evolving composition of synthetic cathinones found in bath salt products.
近年来，作为“浴盐”或“植物肥料”销售的设计药物的使用急剧增加。在这些产品中已经确定了几种不同的合成卡西酮，包括甲卡西酮、3,4-亚甲二氧基吡咯戊酮（MDPV）和 4-氟甲卡西酮（氟苯丙胺）。我们报告了一例因吸食浴盐导致血清和尿液中 MDPV 和氟苯丙胺定量水平升高以及从浴盐产品中中毒的病例。
一名 23 岁男性，有先前的精神病史，因据称吸入浴盐后出现怪异行为、自杀意念和幻觉，通过急诊医疗服务（EMS）送达。他的血清和尿液中的 MDPV 水平分别为 186 和 136ng/ml，血清和尿液中的氟苯丙胺水平分别为 346 和 257ng/ml。送检的白色粉末中发现每毫克粉末含有 143μg MDPV 和 142μg 氟苯丙胺。他的精神病和激越在急诊室接受劳拉西泮、氟哌啶醇和观察治疗后得到缓解。
MDPV 可引起激越、精神病、运动障碍、心动过速和高血压；尚无详细描述氟苯丙胺临床经验的先前报告。鉴于我们患者的血清氟苯丙胺水平是 MDPV 水平的两倍，氟苯丙胺很可能导致了他的临床毒性。该病例提示，类似氟苯丙胺的氟代卡西酮可能改变了代谢和/或消除途径，从而影响其临床毒性过程。该病例突出了在浴盐产品中发现的合成卡西酮组成的不断演变。
