1
|
Riley AL, Nelson KH, To P, López-Arnau R, Xu P, Wang D, Wang Y, Shen HW, Kuhn DM, Angoa-Perez M, Anneken JH, Muskiewicz D, Hall FS. Abuse potential and toxicity of the synthetic cathinones (i.e., “Bath salts”). Neurosci Biobehav Rev 2020; 110:150-173. [DOI: 10.1016/j.neubiorev.2018.07.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/14/2018] [Accepted: 07/24/2018] [Indexed: 01/22/2023]
|
2
|
Olesti E, Rodríguez-Morató J, Gomez-Gomez A, Ramaekers JG, de la Torre R, Pozo OJ. Quantification of endogenous neurotransmitters and related compounds by liquid chromatography coupled to tandem mass spectrometry. Talanta 2018; 192:93-102. [PMID: 30348434 DOI: 10.1016/j.talanta.2018.09.034] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/27/2022]
Abstract
Neurotransmitters are signaling molecules, playing key roles in neuronal communications in the brain. Drug induced changes in neurotransmitters and other brain metabolite concentration may be used to characterize drugs according to their targeted metabolomics profile. Here, we report the development and validation of a straightforward liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the simultaneous quantification of 16 endogenous small polar compounds in rat plasma and brain homogenates. The method enables the quantification of the neurotransmitters γ-aminobutyric acid, glutamate, acetylcholine and adenosine, as well as choline, glutamine, acetylcarnitine, carnitine, creatine, creatinine, valine, leucine, isoleucine, phenylalanine, tyrosine and tryptophan. After optimizing the sample preparation, chromatographic and spectrometric conditions, the method was successfully validated using the standard addition approach and a hydrophilic interaction chromatography (HILIC) with an amide column. The method was shown to be linear (r > 0.99) as all the compounds were within the ±25% values of intra and inter-day precision and accuracy acceptance. A matrix effect was corrected with the use of 10 isotopically labelled internal standards and the compound stability was evaluated for all compounds. Relevant exaltation of choline (in plasma) and creatinine (in brain) were solved with -20 °C conditions. The applicability of the method was tested by evaluating brain alterations in the concentrations of neurotransmitters and related compounds after the administration of two psychostimulant drugs of abuse (cocaine and methylenedioxypyrovalerone) to rats. A neuro-metabolic fingerprint of each drug was obtained that reflected their pharmacological profile. Altogether, this methodology presents a valuable targeted metabolomics tool for basic and clinical research studies.
Collapse
Affiliation(s)
- Eulàlia Olesti
- Integrative Pharmacology & Systems Neuroscience Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental & Health Sciences, Universitat Pompeu Fabra (CEXS-UPF), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Jose Rodríguez-Morató
- Integrative Pharmacology & Systems Neuroscience Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental & Health Sciences, Universitat Pompeu Fabra (CEXS-UPF), Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN, CB06/03/028), 15706 Santiago de Compostela, Spain
| | - Alex Gomez-Gomez
- Integrative Pharmacology & Systems Neuroscience Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental & Health Sciences, Universitat Pompeu Fabra (CEXS-UPF), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Johannes G Ramaekers
- Experimental Psychopharmacology Unit, Department of Neurocognition, Faculty of Psychology, Maastricht University, Maastricht, the Netherlands
| | - Rafael de la Torre
- Integrative Pharmacology & Systems Neuroscience Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental & Health Sciences, Universitat Pompeu Fabra (CEXS-UPF), Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN, CB06/03/028), 15706 Santiago de Compostela, Spain
| | - Oscar J Pozo
- Integrative Pharmacology & Systems Neuroscience Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain.
| |
Collapse
|
3
|
Bontempo LJ, Magidson PD, Hayes BD, Martinez JP. Acute Pulmonary Injury after Inhalation of Free-Base Cocaine: A Case Report. J Acute Med 2017; 7:82-86. [PMID: 32995177 DOI: 10.6705/j.jacme.2017.0702.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Many patients presenting to urban emergency departments (EDs) have chief complaints directly related to the use of illicit drugs. Given the reluctance of patients to admit to their use of cocaine, it is important for the emergency medicine provider (EMP) to recognize key epidemiologic principles as well as features of the history, physical examination, and diagnostic studies that suggest the sequelae of cocaine abuse. Case Presentation We describe our assessment of an otherwise healthy 47-year-old man with the acute onset of pleuritic chest pain accompanied by hypoxia, radiographic evidence of diffuse alveolar hemorrhage (DAH), and an elevated creatine phosphokinase (CPK) level. The patient vehemently denied active cocaine abuse. No clear pulmonary, cardiac, or infectious explanations for his signs and symptoms were readily apparent. Ultimately, after further workup and urine toxicology screening, the cause of this patient's chest pain and hypoxia was determined to be DAH related to his recent inhalation of crack cocaine. The patient was treated with systemic corticosteroids and improved. Conclusion Nearly 41% of patients who present to the ED because of complications of inhaled cocaine use are experiencing pleuritic chest pain, and more than half have an elevated CPK concentration. As many as 40% of these patients deny using the drug when asked. These data are important for EMPs to know when formulating a differential diagnosis for patients presenting with pleuritic chest discomfort.
Collapse
Affiliation(s)
- Laura J Bontempo
- University of Maryland School of Medicine Department of Emergency Medicine Baltimore, MD United States
| | - Phillip D Magidson
- University of Maryland School of Medicine Department of Emergency Medicine Baltimore, MD United States
| | - Bryan D Hayes
- University of Maryland School of Medicine Department of Emergency Medicine Baltimore, MD United States
| | - Joseph P Martinez
- University of Maryland School of Medicine Department of Emergency Medicine Baltimore, MD United States
| |
Collapse
|
4
|
Goldberg A. Superimposed cocaine-induced rhabdomyolysis in a patient with aortic dissection rhabdomyolysis. ACTA ACUST UNITED AC 2015; 4:75-7. [PMID: 25774753 DOI: 10.1213/xaa.0000000000000122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 52-year-old man presented with acute, sharp chest pain radiating to the back and abdomen after using cocaine 18 hours previously. Computed tomographic angiography revealed a type B aortic dissection that extended to the iliac arteries. The patient underwent balloon fenestration, placement of multiple aortic stents, and bilateral leg fasciotomy. He eventually went into hyperkalemic arrest but was successfully resuscitated, after which his serum lactate and creatine kinase levels peaked at 7.4 mmol/L and 990,400 U/L, respectively. The combination of aortic dissection and creatine kinase toxicity was extensive enough to cause permanent renal failure and paraplegia below T6. The severity of the patient's symptoms was attributed to concomitant cocaine-induced rhabdomyolysis and aortic dissection rhabdomyolysis.
Collapse
Affiliation(s)
- Andrew Goldberg
- From the Department of Anesthesiology, Mount Sinai Medical Center, New York, New York
| |
Collapse
|
5
|
Penders TM, Gestring RE, Vilensky DA. Excited delirium following use of synthetic cathinones (bath salts). Gen Hosp Psychiatry 2012; 34:647-50. [PMID: 22898445 DOI: 10.1016/j.genhosppsych.2012.06.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 02/04/2023]
Abstract
Synthetic analogs of the cathinone molecule have seen increasing recreational use as substitutes for cocaine, 3,4-methylenedioxymethamphetamine (ecstasy) and methamphetamine. Repeated use of these drugs is associated with a paranoid hallucinatory delirium. A subset of patients using these substances develops a syndrome of extreme agitation and violent behavior that has been reported following the use of other stimulant drugs that also produce rapid changes in brain monoamines. This syndrome, characterized as "excited delirium," presents to the acute care setting with a challenging combination of paranoia, severe agitation and violent behavior. These patients frequently suffer from dehydration, skeletal muscle damage and renal failure that may lead to multiorgan failure and death. Management of these individuals requires careful consideration of the consequences of interventions commonly implemented in medical settings to control dangerous aggressive behavior.
Collapse
Affiliation(s)
- Thomas M Penders
- Department of Psychiatric Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | | | | |
Collapse
|
6
|
[Dialysis for severe rhabdomyolysis 7 days after multiple trauma]. Anaesthesist 2012; 61:224-6, 228. [PMID: 22430552 DOI: 10.1007/s00101-012-1987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 12/09/2011] [Accepted: 01/08/2012] [Indexed: 10/28/2022]
Abstract
A case report of severe rhabdomyolysis in a 33-year-old motorcyclist after multiple trauma is described. The injuries included severe thoracic and abdominal trauma as well as injuries to the extremities and spinal column. During the first 3 days of treatment a forced volume therapy was performed because of increased levels of creatine kinase during which the patients condition stabilized both hemodynamically and respiratorily. On day 10 the patient developed a rise in temperature to 42°C with no evidence of a re-infection and the creatine kinase levels rose to 109,830 U/l. A continuous hemofiltration was started because of acute renal failure. The creatine kinase levels declined significantly and renal function also returned to normal with adequate diuresis up to day 20. After intensive questioning of the relatives a history of long-term use of anabolic steroids, clenbuterol as well as the intake of testosterone enanthate was conceded. Cocaine and amphetamines were also taken regularly by the patient.
Collapse
|
7
|
Stevenson S, Judkins K, Phipps A. An alternative cause of raised creatine kinase in burns patients. Burns 2008; 34:581-2. [DOI: 10.1016/j.burns.2007.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 08/28/2007] [Indexed: 11/28/2022]
|
8
|
Elevations in Creatine Kinase and Hepatic Transaminases in an HIV-Positive Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2006. [DOI: 10.1097/01.idc.0000194288.47201.1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Abstract
Current estimates establish that more than 30 million people in the United States use cocaine. Cardiovascular complaints commonly occur among patients who present to emergency departments(EDs) after cocaine use, with chest pain the most common complaint in several studies. Although myocardial ischemia and infarction account for only a small percentage of cocaine-associated chest-pain, physicians must understand the pathophysiology of cocaine and appropriate diagnostic and treatment strategies to best manage these patients and minimize adverse outcomes. This article reviews the pharmacology of cocaine, its role in the pathogenesis of chest pain with specific emphasis on inducing myocardial ischemia and infarction, and current diagnostic and management strategies for cocaine-associated chest pain encountered in the ED.
Collapse
Affiliation(s)
- Joel T Levis
- Kaiser Santa Clara Medical Center, Department of Emergency Medicine, CA 95051, USA.
| | | |
Collapse
|
10
|
Fernandez WG, Hung O, Bruno GR, Galea S, Chiang WK. Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis. Am J Emerg Med 2005; 23:1-7. [PMID: 15672329 DOI: 10.1016/j.ajem.2004.09.025] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE We assessed the primary causes of rhabdomyolysis, the factors associated with the development of acute renal failure (ARF), and the need for hemodialysis (HD) among a series of patients presenting to an urban emergency department with rhabdomyolysis. METHODS A chart review between January 1992 and December 1995 was conducted of patients aged 18 years or older with a diagnosis of rhabdomyolysis and an initial serum creatine phosphokinase greater than 1000 U/L. Patients were excluded if they had evidence of myocardial ischemia, cerebrovascular insufficiency, or the development of rhabdomyolysis after hospitalization. Demographic information, presumed causative factors, past medical history, medication usage, and laboratory data were collected. RESULTS Ninety-seven patients (93 men, 4 women) were enrolled, with a mean age of 35.7 years. The most common causes of rhabdomyolysis were cocaine (30), exercise (29), and immobilization (18). Seventeen of 97 (17.5%) patients developed ARF; 8 patients (8.25%) needed HD. Several clinical and laboratory factors were statistically associated with development of ARF and need for HD. The only variable that was predictive of both ARF and need for HD in separate multivariate regression models was the initial creatinine (Cr). Initial blood urea nitrogen also was predictive of the need for HD. No patient developed ARF with an initial Cr less than 1.7 mg/dL. CONCLUSION Acute renal failure and need for HD are common complications of rhabdomyolysis. Except for initial serum Cr and blood urea nitrogen, clinical and laboratory factors were not reliable predictors for the development of ARF or need for HD.
Collapse
Affiliation(s)
- William G Fernandez
- Department of Emergency Medicine, New York University/Bellevue Hospital Center, NY 10016, USA.
| | | | | | | | | |
Collapse
|
11
|
Joshi MK, Liu HH. Acute rhabdomyolysis and renal failure in HIV-infected patients: risk factors, presentation, and pathophysiology. AIDS Patient Care STDS 2000; 14:541-8. [PMID: 11054938 DOI: 10.1089/108729100750018308] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Rhabdomyolysis is a common cause of acute renal failure and may be related to a variety of predisposing factors. This entity has been increasingly recognized in HIV-infected individuals and is an important cause of morbidity and mortality. We present a series of seven HIV-positive patients admitted with rhabdomyolysis over a 5-year period; three developed acute renal failure. Infections and substance abuse were the most common risk factors identified; an average of three predisposing factors was present in each case. All patients showed resolution of creatinine phosphokinase (CPK) elevation and serum creatinine returned to the normal range in the three patients who developed renal insufficiency; however, all patients required prolonged hospitalization and one patient died of sepsis. The pathophysiological mechanisms of muscle injury in our patients are reviewed and their bearing on prognosis discussed. It is concluded that clinicians should have a high index of suspicion for the development of rhabdomyolysis in HIV-infected patients with a combination of noncompliance with medical therapy and/or substance abuse and acute infection. With comprehensive supportive care, the prognosis of acute rhabdomyolysis in this population may be reasonably good.
Collapse
|
12
|
Abstract
Rhabdomyolysis is a disorder in which injury to muscle results in leakage of myocyte intracellular contents into the plasma. It has been associated with a tremendous number and diversity of clinical conditions and substances. Several physiological and biochemical mechanisms for this syndrome have been described. The most likely etiology of rhabdomyolysis in patients presenting to the emergency department is ingestion of drugs of abuse, most commonly ethanol, heroin, amphetamines, cocaine, and other sedatives or stimulants. In this article, the association between rhabdomyolysis and drugs of abuse is explored, as well as its diagnosis and treatment.
Collapse
Affiliation(s)
- J R Richards
- Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento 95817, USA
| |
Collapse
|
13
|
Chanmugam AS, Hengeller M, Ezenkwele U. Development of rhabdomyolysis after rapid opioid detoxification with subcutaneous naltrexone maintenance therapy. Acad Emerg Med 2000; 7:303-5. [PMID: 10730843 DOI: 10.1111/j.1553-2712.2000.tb01084.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A S Chanmugam
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | |
Collapse
|
14
|
Richards JR, Johnson EB, Stark RW, Derlet RW. Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study. Am J Emerg Med 1999; 17:681-5. [PMID: 10597089 DOI: 10.1016/s0735-6757(99)90159-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Patients with methamphetamine toxicity are presenting in greater numbers each year to emergency departments (ED) in the US. These patients are frequently agitated, violent, and often require physical and chemical restraint. The incidence and risk of rhabdomyolysis in this subpopulation is unknown. We conducted a 5-year retrospective review of all ED patients who received the final diagnosis of rhabdomyolysis. Patients with toxicology screens positive for methamphetamine were identified, and demographics, laboratory results, resource utilization, disposition, and outcome were compared to the remaining patients. Of the total 367 patients identified, 166 (43%) were toxicology positive for methamphetamine. Methamphetamine patients differed significantly from nonmethamphetamine patients with regard to demographics and hospital utilization. Methamphetamine patients had significantly higher mean initial creatine phosphokinase (CK), 12,439 U/L versus 5,678 U/L (P = 0.02), and lower mean peak CK, 16,827 U/L versus 19,426 U/L (P = 0.03). The development of acute renal failure was not significantly different between the 2 groups. There were 16 total deaths in the study population, 11 from concomitant infection/sepsis. An association between methamphetamine abuse and rhabdomyolysis may exist, and CK should be measured in the ED as a screen for potential muscle injury in this subpopulation. Patients with rhabdomyolysis with an unclear cause should be screened for methamphetamine or other illicit drugs.
Collapse
Affiliation(s)
- J R Richards
- Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento, USA
| | | | | | | |
Collapse
|
15
|
Kontos MC, Schmidt KL, Nicholson CS, Ornato JP, Jesse RL, Tatum JL. Myocardial perfusion imaging with technetium-99m sestamibi in patients with cocaine-associated chest Pain. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80001-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|