Cristalius: a case in designer drugs

Among recreational drug users, there is a new wave of designer drugs being marketed as "bath salts" and "plant food," which mimic the effects of cocaine/amphetamines and ecstasy (MDMA [3,4-methylenedioxy-N-methamphetamine]). Presented is the case of a patient who snorted a bath salt called Cristalius.

A 22-year-old male Soldier was seen in an emergency department for syncope, agitation, confusion, and tachycardia. He reported snorting 1 g of Cristalius the night before. Significant labs included a creatine kinase of 668 U/L, serum creatinine of 1.35 mg/dL, and troponin of 0.516 ng/mL. His abnormal labs trended to normal and a computed tomography coronary angiogram was unremarkable.

The main ingredients postulated in these products are mephedrone and a synthetic cathinone derivatives of the khat plant. The intended effects include euphoria, empathic connection, mood enhancement, increased sensory perception, with decreased inhibition. Unwanted sympathomimetic side effects include hypertension, tachycardia, chest pain, diaphoresis, dilated pupils, seizures, bruxism, and headaches. Neuropsychiatric symptoms include agitation, anxiety, paranoia, tremors, and insomnia.

No treatment guidelines currently exist for mephedrone or MDPV (3,4-methylenedioxypyrovalerone) toxicity. If suspected, ensure adequate cardiac evaluation is completed regardless of age. Appropriate supportive care and addressing any complications is the primary treatment.