The serotonin syndrome as a result of mephedrone toxicity

Abstract

A 22-year-old male presented to an emergency department by ambulance. His clinical picture included tachycardia, diaphoresis, hypertonia, hyper-reflexia and clonus. The patient became hyperthermic and deteriorated over the next hour. The principal substance ingested was mephedrone and appropriate treatment for the serotonin syndrome resulted in a sustained recovery over 15 h. BACKGROUND

Bath Salts: Not as Harmless as They Sound

“…The hyperthermia is similar to the ecstasy-induced rise in body temperature that occurs as a symptom of serotonin syndrome, along with the potent peripheral vasoconstriction due to overwhelming alpha-adrenergic receptor stimulation. 39 Left uncontrolled, the increasing hyperthermia may lead to the development of metabolic acidosis, disseminated intravascular coagulation (DIC), muscle breakdown with subsequent rhabdomyolysis, and renal failure. 39 Health care personnel have reported cool, pale, and cyanotic painful extremities in patients, confirming the potent vasoconstrictor properties.…”

“…39 Left uncontrolled, the increasing hyperthermia may lead to the development of metabolic acidosis, disseminated intravascular coagulation (DIC), muscle breakdown with subsequent rhabdomyolysis, and renal failure. 39 Health care personnel have reported cool, pale, and cyanotic painful extremities in patients, confirming the potent vasoconstrictor properties. 40 The cardiovascular effects have been reported to last for several hours to a few days after ingestion.…”

“…4,10,25,30,37 The judicious use of benzodiazepines has shown the most promise to help control many of the extreme effects experienced by the user. 10,35,39 Acutely psychotic or dangerous patients should be treated with benzodiazepines such as midazolam or lorazepam, followed by a rapidly acting antipsychotic agent, but one that will not lower the seizure threshold. 4,25,30 Benzodiazepines will help ease tremors and the hyperactivity, which will help lower body metabolism and temperature.…”

Recognition and mangement of serotonin syndrome

“…Case reports indicate that these novel substances may also be implicated in serotonin syndrome. [7][8][9] Serotonergic agents may act in any of the following ways to contribute to a clinical picture of serotonin syndrome: increased synthesis of serotonin; increased release of serotonin from cells; decreased reuptake of serotonin by cells; inhibition of the enzymes responsible for metabolising serotonin Given the widespread use of serotonergic agents and the associated risk of potentially life threatening illness as a result of their use, it is important that prescribers have a sound understanding of serotonin syndrome, its consequences and management. (monoamine oxidase, MAO); and antagonism of serotonin receptors.…”

Is your patient high on “bath salts”?

“…26 Hyperthermia increases the risk for rhabdomyolysis, renal failure, metabolic acidosis, disseminated intravascular coagulation, coma, and death. An elevated body temperature after use of mephedrone, a common component of bath salts, can suggest a serotonin syndrome-induced hyperthermia.…”