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Cathinones

("Bath Salts")

By Gerald F. O’Malley, DO, Professor of Emergency Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University and Hospital ; Rika O’Malley, MD, Attending Physician, Department of Emergency Medicine, Einstein Medical Center

(See also Drug Use and Abuse.)

Cathinone is an amphetamine-like stimulant derived from the plant Catha edulis (khat). The khat plant is a shrub grown in East Africa and on the Arabian peninsula. For centuries, people there have chewed the leaves for their mild stimulant effect. In those regions, chewing khat is often a social activity, similar to coffee drinking in other societies.

Recently, khat use has spread to other countries, and much stronger, man-made (synthetic) cathinones marketed as "bath salts" have become drugs of abuse.

Symptoms

The effects of synthetic cathinones are similar to those of amphetamines and include headache, a rapid heart rate (tachycardia), palpitations, hallucinations, agitation, and an increased endurance and tolerance for pain. Some people become violent.

Complications

Cathinones can cause a dangerously high body temperature (hyperthermia). They also may cause serious organ damage, although doctors are not sure why. Organ damage can include

Diagnosis

  • A doctor's evaluation

  • Blood and urine tests

Because synthetic cathinones are not detected with routine urine or blood testing, doctors usually base the diagnosis on symptoms in people known to have used the drug. Doctors typically order the following specific tests for anyone showing signs of severe acute cathinone intoxication:

  • Blood tests (to check blood count, levels of electrolytes, and kidney function)

  • Urine testing for myoglobinuria (to test for muscle destruction)

Treatment

  • IV sedatives

  • IV fluids

Typical treatments, which include IV sedatives and fluids and supportive care, are usually adequate. People with dangerously high body temperature (hyperthermia), persistently high heart rate or agitation, and blood tests that suggest possible kidney problems should be hospitalized and monitored for muscle breakdown and heart and kidney damage.

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