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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

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Cathinones are compounds related to the stimulant alkaloid derived from the plant Catha edulis (khat).

The khat plant is native to the Horn of Africa and Arabian peninsula. Its leaves contain cathinone, an amphetamine-like alkaloid. For centuries, inhabitants of the plant's native area have chewed the leaves for a mild euphoriant and 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 more recently a number of derivatives of the base alkaloid have been synthesized and become drugs of abuse.

Derivatives include the drugs known as bath salts, often containing the substituted cathinones mephedrone or methylenedioxypyrovalerone. However, the actual structures change frequently. The products have been termed "bath salts" and labeled "not for human consumption" to avoid legal challenge. Reported use of substituted cathinones increased several thousand-fold from 2010–2011.

The physiologic effects of the substituted cathinones are similar to those of amphetamines and include the potential to cause myocardial infarction, rhabdomyolysis, renal failure, and liver failure. However, the exact mechanism responsible for organ damage is unknown.

Patients may present with headache, tachycardia and palpitations, hallucinations, agitation, an increased endurance and tolerance for pain, and propensity for violent behavior.

Diagnosis is made by clinical evaluation; substituted cathinones are not detected with routine urine or blood testing. Patients with severe acute intoxication should typically have blood tests (CBC, electrolytes, BUN, creatinine, CK), urine testing for myoglobinuria, and ECG.

Sedation with IV benzodiazepines, IV fluids, and supportive care are typically adequate. Patients with hyperthermia, persistent tachycardia or agitation, and elevated serum creatinine should be admitted for further monitoring for rhabdomyolysis and cardiac and renal injury.