Cristalius: A Case in Designer Drugs

Abstract

Introduction: Among recreational drug users, there is a new wave of designer drugs being marketed as "bath salts" and "plant food," which mimic the effects of cocaine/amphetamines and ecstasy (MDMA [3,). Presented is the case of a patient who snorted a bath salt called Cristalius. Case presentation: A 22-year-old male Soldier was seen in an emergency department for syncope, agitation, confusion, and tachycardia. He reported snorting 1 g of Cristalius the night before. Significant labs included a creatine kinase of 668 U/L, serum creatinine of 1.35 mg/dL, and troponin of 0.516 ng/mL. His abnormal labs trended to normal and a computed tomography coronary angiogram was unremarkable. Discussion: The main ingredients postulated in these products are mephedrone and a synthetic cathinone derivatives of the khat plant. The intended effects include euphoria, empathic connection, mood enhancement, increased sensory perception, with decreased inhibition. Unwanted sympathomimetic side effects include hypertension, tachycardia, chest pain, diaphoresis, dilated pupils, seizures, bruxism, and headaches. Neuropsychiatric symptoms include agitation, anxiety, paranoia, tremors, and insomnia. Conclusion: No treatment guidelines currently exist for mephedrone or MDPV (3,4-methylenedioxypyrovalerone) toxicity. If suspected, ensure adequate cardiac evaluation is completed regardless of age. Appropriate supportive care and addressing any complications is the primary treatment.

Mephedrone and Nicotine: Oxidative Stress and Behavioral Interactions in Animal Models

“…Many of the available studies indicate that amphetamines increase neuropsychiatric symptoms like anxiety in animal models as well as humans [ 34 – 37 ]. On the other hand, den Hollander et al [ 38 ] observed that anxiety- and depression-related behaviors did not appear after mephedrone administration using binge like regimen.…”

Influence of Contingent and Noncontingent Drug Histories on the Development of High Levels of MDPV Self-Administration

“…Although they vary in selectivity for the dopamine, norepinephrine and serotonin transporters, their effects are similar to prototypical illicit stimulants (e.g., cocaine, methamphetamine, or 3,4-methylenedioxymethamphetamine [MDMA]). Synthetic cathinone users often report repeated bouts of drug administration (i.e., binges) over hours/days, using more drug than intended, high amounts of drug craving, and euphoric effects stronger than those of cocaine (e.g., Winstock et al, 2011;Lenz et al, 2013;Stoica and Felthous, 2013). Synthetic cathinone use also results in a large number of emergency room visits and calls to poison control centers due to acute toxicity, including hypertension, tachycardia, anxiety, and paranoia (e.g., Winstock et al, 2011;Lenz et al, 2013;Stoica and Felthous, 2013).…”

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

“…396 The temperature regulation effect of several of the drugs is an added source of arrhythmogenesis. [397][398][399] A majority of peo ple who overdose have >1 drug in their system either because they purposely took multiple drugs or because the drug they knowingly took was mixed with other drugs without their knowledge. Patients with drug overdoses of these substances should undergo elec trocardiographic monitoring until they are free of the influence of the drug and are ready for discharge from acute care.…”

“…Risks include tachyarrhythmias, bradyarrhythmias, MI, hypothermia, hyperthermia, hypertension, acute neu rological and psychological symptoms, and violent behavior. [396][397][398][399] Ingestion of γhydroxybutyrate, origi nally developed as an anesthetic, may lead to excessive depressant side effects. Patients admitted after taking γhydroxybutyrate may have knowingly or unknowingly also ingested other drugs and thus may have additional side effects.…”