Our case study focused on the case of a 36 year old man who was rushed to the hospital after his girlfriend called EMT.\u00a0 He was initially reported to be running naked through the streets, tachycardic, was extremely agitated, paranoid, and lacked the ability to communicate.\u00a0 He also had a high body temperature and was diaphoretic.\u00a0 In terms of pertinent medical history, the man suffered from depression, and had just recently been laid off from his job.\u00a0 In addition, he had a history of alcohol and drug abuse, and was smoking tobacco at the time. He had no known allergies to medications but was but was lactose intolerant and allergic to shellfish.\u00a0 His family had a history of hypertension, coronary disease, and diabetes mellitus.\u00a0 His only medication was fluoxetine, an antidepressant, which he hadn\u2019t taken for 2 weeks.\u00a0 He also had taken bath salts intranasally for the prior 3 days.\u00a0 Initially, the patient was given midazolam and Lorazepam via IV, intubated for airway protection, and sedated with Propofol.\u00a0 A CT scan was taken with no acute pathology.\u00a0 The patient was then transported to the ICU, where he was given benzodiazepines and neuroleptics, as well as endotracheal intubation.<\/p>\n
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Commercially available methcathinone “bath salts”<\/strong><\/p>\n Man chewing khat leaves, a naturally occurring source of cathinone.<\/strong><\/p>\n <\/p>\n Differential Diagnosis<\/b><\/p>\n A clinical differential diagnosis was then conducted with clinical presentation showing: agitated delirium, aggressive violent behavior, hallucinations, paranoia, possible seizure, mydriasis, tachycardia, hypertension, and tachypnea, and diaphoresis.\u00a0 The diagnosis could either be toxic\/metabolic, infectious, psychiatric, traumatic, or hemorrhagic\/ischemic.\u00a0 It was determined that the symptoms most likely showed a toxic\/metabolic cause because the patient had ingested a \u201cbath salt\u201d drug and was showing symptoms related to a toxic cause.\u00a0 For a toxic cause, there are many possible toxidromes that can be caused by different types of toxins.\u00a0 These toxins include anticholinergics, sympathomimetics, analgesics, toxic alcohols.\u00a0 Other possible toxidromes are sedative\/hypnotic withdrawal, hemoglobinopathies, and serotonin syndrome or neuroleptic malignant syndrome.\u00a0 Doctors narrowed down the diagnosis to be caused by a sympathoimetic toxidrome, which is caused by ingestion of amphetamines, cocaine, or other sympathomimetics.\u00a0 Common symptoms associated with sympathomimetic toxidromes are hypertension, tachycardia, psychomotor agitation, diaphoresis, mydriasis, psychotic behavior, seizures, and coronary ischemia.\u00a0 It was known that the patient had ingested bath salts, which is a sympathomimetic toxin.\u00a0 The symptoms the patient was presenting also corresponded with the symptoms associated with those who have a sympathomimetic toxidrome.\u00a0 An initial CBC, or complete blood count test\/blood panel test was conducted.\u00a0 The concentration of lactic acid in the patient\u2019s blood was extremely high and the pH was very low.\u00a0 There was also a high concentration of creatinine and creatine kinase.\u00a0 These results suggested that the patient had metabolic acidosis, or high levels of acidity in the body, as well as rhabdomyolysis, or breakdown of skeletal muscle that can cause renal failure.\u00a0 The final diagnosis was acute ingestion of a synthetic cathinoine (Bath Salts) causing a sympathomimetic toxidrome with psychotic features and an acute lactic acidosis with acute renal failure.<\/p>\n Diagnostic Procedures<\/b><\/p>\n \u00a0\u00a0\u00a0\u00a0 <\/b>A serum test, a blood test using blood plasma with fibrinogens removed, using liquid chromatography with photodiode array detection (LC-PDA) was conducted, and it was positive for Lorazepam, Fluoxetine, Norfluoxetine, and Methcathinone.\u00a0 It was negative for common stimulants such as amphetamines and cocaine.\u00a0 A urine test using class-specific immunoassays was also conducted and was positive for amphetamines and benzodiazepines.\u00a0 The positive reading for amphetamine, however, was a false positive reading caused by Methcathinone cross-reacting in the amphetamine immunoassay conducted.<\/p>\n<\/p>\n
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