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Neurotoxicity following chronic intravenous use of "Russian cocktail"

Figen Varlibas1, Ismail Delipoyraz, Gulbun Yuksel

  • 1Haydarpasa Numune Educational and Research Hospital, Neurology, Istanbul, Turkey. figenvar@yahoo.com

Clinical Toxicology (Philadelphia, Pa.)
|July 9, 2008
PubMed
Abstract

Insights

Chronic intravenous use of the "Russian Cocktail" mixture, containing potassium permanganate, ephedrine, and aspirin, led to manganese toxicity and movement disorders in teenagers. Standard therapies failed to reverse neurological impairments.

Area of Science:

  • Neurology
  • Toxicology
  • Pharmacology

Background:

  • Neurological abnormalities in methcathinone users have been linked to manganese exposure.
  • This study investigates a similar toxicity in patients using a novel intravenous mixture.

Observation:

  • Three adolescent patients presented with extrapyramidal abnormalities and movement disorders after chronic intravenous use of the "Russian Cocktail" (potassium permanganate, ephedrine, aspirin).
  • Two patients exhibited elevated blood manganese levels and characteristic MRI findings (bilateral symmetric T1 hyper-intensities in basal ganglia and cerebellum).
  • Standard treatments (EDTA, levodopa, para-aminosalicylic acid) resulted in subjective improvement and decreased manganese levels but no objective neurological recovery.

Findings:

  • The "Russian Cocktail" likely generates manganese through the chemical reaction of its components.
  • Manganese toxicity is implicated as the primary cause of the observed neurological impairments, potentially exacerbated by methcathinone.

Implications:

  • This case highlights a new route of manganese neurotoxicity associated with recreational drug mixtures.
  • The findings underscore the severe neurological risks of novel psychoactive substance use and the challenges in treating associated toxicities.

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