Acute Stimulant Toxicity from the Use of Ocean Burst and Lunar Wave Bath Salts: Detection of 3-Chlorophenmetrazine and the Cathinones N-ethylpentedrone and Alpha-pyrrolidinoisohexanophenone (alpha PHiP)

Abstract

Background: In this study, we report on a patient with acute stimulant toxicity following the use of two bath salt products purchased over the Internet in the UK, where two novel cathinones and a substituted phenylmorpholine were detected on toxicological screening.Case Report: A 52-year-old male with ADHD presented to ED with chest pain, shortness of breath, sweating, and agitation after nasal insufflation of Internet purchased ‘bath salt’ products “Ocean Burst” and “Lunar Wave”. He was anxious and agitated, but did not have delusions, paranoia or delirium. On examination, he was tachycardic (113bpm), hypertensive (171/115mmHg), and normothermic (36.0°C). He was tremulous, but his tone and reflexes were normal and there was no clonus. Initial blood tests were normal and initial Troponin I was 32.2ng/L; reduced to 28.3ng/L on repeat (low risk for ACS if ≤34 ng/L on repeat). ECG showed sinus rhythm (99bpm) left axis deviation, QTc 462msecs, QRS 100msecs, with no ischaemic changes. He was treated with oral diazepam (total 25mg) and IV fluids in the ED. Following the admission, he required a further 60mg of oral diazepam for ongoing agitation. His symptoms resolved within 24 hours and he was discharged.Analytical Results: Serum, urine and drugs samples analysed using ultra performance liquid chromatography interfaced to high resolution accurate mass spectrometry:- ‘Ocean Burst’: N-ethyl pentedrone, alpha PHiP;- ‘Lunar Wave’: 3-chlorophenmetrazine, 4-methylmethamphetamine, alpha PHiP;- Serum/urine: the cathinones N-ethylpentedrone and alpha-PHiP were detected, along with the substituted phenylmorpholine 3-Chlorophenmetrazine.Conclusion: The novel cathinones detected in this patient, related to the use of ‘bath salts’, were associated with acute stimulant toxicity. Analytical confirmation of NPS products in patients presenting with acute NPS toxicity is important in the surveillance of the NPS currently available and to inform public health interventions

Keywords

• new psychoactive substances
• acute drug toxicity
• cathinones
• bath salts