SESSION TYPE: Critical Care Student/Resident Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Plants are utilized to derive substances for medical therapy and also recreational use. With advances in science and refinement technologies, more potent compounds that are difficult to detect by traditional assays, have been synthesized. Over 40 new compounds were identified by European authorities in 2010. Of the many available on the internet, K2/SPICE in the Herbal marijuana alternatives (HMA)category and BATH SALTS(BS) or synthetic cathinones , are being increasingly seen in the ER. This indicates not only widespread use with easy availability but their propensity to cause life threatening reactions. As intensivists, we need to be aware of their potential, detection and treatment, both during acute intoxication and withdrawal .
CASE PRESENTATION: 37 yr old male with no past medical history was admitted to the ICU with NSTEMI. Within hours he became agitated, aggressive and violent. He had to be sedated with propofol, which in turn required intubation. He required continuous propofol infusion with added benzodiazepines(BZDs) and fentanly dosing for 1 week. He was later found to have used BS. 31 yr old male was admitted with drug overdose and found to have used BS. He required sedation with BZDs along with fentanyl and dexmetomidine and remained intubated for 10 days. 20 yr old male, was admitted for community acquired pneumonia and was subsequently intubated for respiratory failure secondary to ARDS. Family reported synthetic marijuana use. Following extubation he was constantly restless and tachycardic, requiring BZD. It is likely that he was experiencing withdrawal.
DISCUSSION: HMAs are adulterated with synthetic cannabinoids and act by sympathomimetic actions. Brand names are K2 and SPICE. Effects include agitation, paranoia, delusions, tachycardia, diaphoresis. ST-elevation myocardial infarction in adolescents with use of K2 has been reported. Synthetic cannabinoids have serotonin-like and weak monoamine oxidase inhibitor properties, with the potential to cause serotonin syndrome. Withdrawal symptoms include: restlessness, nausea, tremors, sweating and nightmares. Detection is by gas chromatography- mass spectrometry. Treatment is supportive with BZD for severe agitation. BS are known for their amphetamine like effects. Use can be nasally, orally, rectally or intravenously. Effects include heightened alertness, increased energy, sexual arousal and extreme aggression and psychotic behavior. Sympathomimetic effects lead to tachycardia, hypertension, and hyperthermia. MIs and myocarditis have been reported. Drug effect can last for days on repeated re-dosing. Long term effects involve Parkinsonism. Detection is not possible on the traditional drug screens. Treatment involves aggressive supportive measures including heavy sedation against seizures, hyperthermia and other complications.
1) Here Today, Gone Tomorrow and Back Again?. Rosenbaum, C. Etal. Journal of Medical Toxicology. Jan 2012.
DISCLOSURE: The following authors have nothing to disclose: Divyashree Varma, Pratik Dalal
No Product/Research Disclosure InformationSUNY-Upstate Medical University, Syracuse, NY