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, which often contain the substituted cathinones mephedrone or methylenedioxypyrovalerone. However, the actual chemical structures vary based on how they are produced. Cathinones can be inhaled, eaten, smoked, and sometimes injected. The products have been termed "bath salts" because of their resemblance to Epsom salts and labeled "not for human consumption" to avoid legal challenge. Reported use of substituted cathinones increased several thousand-fold from 2010 to 2011, and worldwide seizure of related compounds by drug enforcement authorities increased significantly in early 2017 over a comparable time period in 2016.
Pathophysiology of Cathinone Toxicity
The physiologic effects of the substituted cathinones are similar to those of amphetamines Symptoms and Signs Amphetamines are sympathomimetic drugs with central nervous system stimulant and euphoriant properties whose toxic adverse effects include delirium, hypertension, seizures, and hyperthermia... read more and include the potential to cause myocardial infarction Acute Myocardial Infarction (MI) Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of a coronary artery. Symptoms include chest discomfort with or without dyspnea, nausea, and/or diaphoresis... read more , rhabdomyolysis Rhabdomyolysis Rhabdomyolysis is a clinical syndrome involving the breakdown of skeletal muscle tissue. Symptoms and signs include muscle weakness, myalgias, and reddish-brown urine, although this triad is... read more , renal failure Acute Kidney Injury (AKI) Acute kidney injury is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous products in the blood (azotemia) with or without reduction in amount of urine... read more , and liver failure Acute Liver Failure Acute liver failure is caused most often by drugs and hepatitis viruses. Cardinal manifestations are jaundice, coagulopathy, and encephalopathy. Diagnosis is clinical. Treatment is mainly supportive... read more . However, the exact mechanism responsible for organ damage is unknown.
Signs and Symptoms of Cathinone Toxicity
Patients may present with headache, tachycardia and palpitations, hallucinations, agitation, an increased endurance and tolerance for pain, and propensity for violent behavior.
Diagnosis of Cathinone Toxicity
Usually a clinical diagnosis
Diagnosis is made by clinical evaluation; substituted cathinones are not detected with routine urine or blood testing. Patients with severe acute intoxication should be evaluated for rhabdomyolysis Rhabdomyolysis Rhabdomyolysis is a clinical syndrome involving the breakdown of skeletal muscle tissue. Symptoms and signs include muscle weakness, myalgias, and reddish-brown urine, although this triad is... read more and may need blood tests (complete blood count, electrolytes, blood urea nitrogen, creatinine, creatine kinase), urine testing for myoglobinuria, and ECG.
Treatment of Cathinone Toxicity
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.
Drugs Mentioned In This Article
|Drug Name||Select Trade|
|Aluvea , BP-50% Urea , BP-K50, Carmol, CEM-Urea, Cerovel, DermacinRx Urea, Epimide-50, Gord Urea, Gordons Urea, Hydro 35 , Hydro 40, Kerafoam, Kerafoam 42, Keralac, Keralac Nailstik, Keratol, Keratol Plus, Kerol, Kerol AD, Kerol ZX, Latrix, Mectalyte, Nutraplus, RE Urea 40, RE Urea 50 , Rea Lo, Remeven, RE-U40, RYNODERM , U40, U-Kera, Ultra Mide 25, Ultralytic-2, Umecta, Umecta Nail Film, URALISS, Uramaxin , Uramaxin GT, Urea, Ureacin-10, Ureacin-20, Urealac , Ureaphil, Uredeb, URE-K , Uremez-40, Ure-Na, Uresol, Utopic, Vanamide, Xurea, X-VIATE|