Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida College of Medicine, Gainesville, USA.
Am J Med. 2012 Sep;125(9):854-8. doi: 10.1016/j.amjmed.2012.02.019. Epub 2012 Jun 9.
Abuse of the psychoactive "designer drug" methylenedioxypyrovalerone (MDPV) has become a serious international public health concern because of the severity of its physical and behavioral toxicities. MDPV is the primary ingredient in so-called "bath salts," labeled as such to avoid criminal prosecution and has only been classified recently as a controlled substance in the United States and some other countries. However, it remains a danger because of illegal sources, including the Internet. MDPV is a synthetic, cathinone-derivative, central nervous system stimulant and is taken to produce a cocaine- or methamphetamine-like high. Administered via oral ingestion, nasal insufflation, smoking, intravenous or intramuscular methods, or the rectum, the intoxication lasts 6 to 8 hours and has high addictive potential. Overdoses are characterized by profound toxicities, causing increased attention by emergency department and law enforcement personnel. Physical manifestations range from tachycardia, hypertension, arrhythmias, hyperthermia, sweating, rhabdomyolysis, and seizures to those as severe as stroke, cerebral edema, cardiorespiratory collapse, myocardial infarction, and death. Behavioral effects include panic attacks, anxiety, agitation, severe paranoia, hallucinations, psychosis, suicidal ideation, self-mutilation, and behavior that is aggressive, violent, and self-destructive. Treatment is principally supportive and focuses on counteracting the sympathetic overstimulation, including sedation with intravenous benzodiazepines, seizure-prevention measures, intravenous fluids, close (eg, intensive care unit) monitoring, and restraints to prevent harm to self or others. Clinical presentation is often complicated by coingestion of other psychoactive substances that may alter the treatment approach. Clinicians need to be especially vigilant in that MDPV is not detected by routine drug screens and overdoses can be life-threatening.
滥用具有致幻作用的“设计毒品” 3,4-亚甲基二氧吡咯戊酮（MDPV）已经成为一个严重的国际公共卫生问题，因为其对身体和行为的毒性非常严重。MDPV 是所谓“浴盐”的主要成分，之所以这样命名是为了避免刑事起诉，最近才被美国和其他一些国家列为受控物质。然而，由于其非法来源，包括互联网，它仍然是一种危险物质。MDPV 是一种合成的、来源于金刚烷的、作用于中枢神经系统的兴奋剂，服用后会产生类似可卡因或冰毒的兴奋感。通过口服、鼻腔吸入、吸烟、静脉或肌肉注射或直肠给药，中毒持续 6 到 8 小时，具有很高的成瘾性。过量会导致严重的毒性，引起急诊室和执法人员的高度关注。身体表现从心动过速、高血压、心律失常、体温过高、出汗、横纹肌溶解和癫痫发作到严重到中风、脑水肿、心肺衰竭、心肌梗死和死亡。行为影响包括惊恐发作、焦虑、躁动、严重偏执、幻觉、精神病、自杀意念、自残和具有攻击性、暴力和自我毁灭倾向的行为。治疗主要是支持性的，侧重于对抗交感神经过度刺激，包括静脉注射苯二氮䓬类镇静、预防癫痫发作的措施、静脉输液、密切（如重症监护病房）监测和约束，以防止对自己或他人造成伤害。临床表现常常因同时摄入其他可能改变治疗方法的精神活性物质而变得复杂。临床医生需要特别警惕，因为常规药物筛查无法检测到 MDPV，而且过量可能危及生命。
