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Profound Hyperthermia Associated With Fentanyl and Cocaine Use With Suspected Synephrine Adulteration
Ashley J Choe1, Ross Ellison2, Sunil R Ramaswamy1
1Department of Medicine, University of Rochester Medical Center, Rochester, New York.
The Journal of Emergency Medicine
|February 13, 2023
Summary
Synephrine, an adulterant in illicit drugs, can cause severe and prolonged hyperthermia. Prompt recognition and aggressive cooling are crucial for managing this potentially fatal condition.
Area of Science:
- Emergency Medicine
- Clinical Toxicology
Background:
- Hyperthermia is a known complication of cocaine intoxication.
- Two cases of severe, prolonged hyperthermia were observed following recreational drug use.
Observation:
- Synephrine was identified in high concentrations in both patients' biological samples.
- The hyperthermia presented with delayed onset and protracted duration in both cases.
Findings:
- One patient experienced multisystem organ failure and significant morbidity despite aggressive cooling.
- The second patient, receiving prompt and aggressive cooling, recovered within three days.
Implications:
- Synephrine is a suspected adulterant associated with profound hyperthermia.
- Emergency physicians must be aware of synephrine's potential for severe hyperthermia.
- Early recognition and targeted management, including aggressive cooling, can prevent severe outcomes.
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