Identification of the drug of abuse flakka (α-PVP) as suspicion of chemical submission in the Emergency Department of a tertiary hospital

Fernández Alonso, Cesáreo; Quintela Jorge, Oscar; Santiago Sáez, Andrés Sebastián

doi:10.1016/j.medcle.2016.03.035

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Emergency services are at the forefront of care for patients who suffer any type of acute intoxication, for which it has up-to-date protocols.<a class="elsevierStyleCrossRef" href="#bib0040">3</a> There are a number of recommended medical and legal guidelines for cases of suspected CS.<a class="elsevierStyleCrossRef" href="#bib0035">2</a>We report the case of a 53-year-old male of Spanish nationality, with no medical history except anxiety and a normal consumption of benzodiazepines, who visited the A&E of Hospital Clínico San Carlos in the summer of 2015. The patient reported having inhaled a white substance provided by unknown people resulting in an ATM robbery in public, along with psychomotor restlessness, chest pains and palpitations that persisted for about 6h, until his visit. No significant findings were observed in the physical examination. Additional tests found mild leukocytosis and acute renal failure. The toxin analysis, through an immunoassay of urine, detected benzodiazepines, but no cocaine, amphetamines, opiates or cannabis metabolites were identified. The hospital CS registration and legal protocol was activated which involves the extraction of biological samples (blood and urine) and subsequent storage under chain of custody before the patient signs an informed consent. The patient was also advised to report the incident to the police. After two cardiac enzyme analysis, electrocardiograms with no abnormality and confirmation of haemodynamic stability, the patient was discharged after 10h. Six months later an analysis of the patient's biological samples was performed at the National Institute of Toxicology and Forensic Sciences (INTCF), which detected nordiacepam (<0.1mg/l) and α-pyrrolidinovalerophenone (α-PVP) 0.009mg/l; in addition the urine sample tested positive for α-PVP, lorazepam, oxazepam and metamizol. The results indicated that the patient was exposed to those drugs and the drug of abuse α-PVP.The clinical case presented is of interest as confirmation of non-fatal consumption of the drug of abuse α-PVP, although this is not the first time that it has been identified in our country (previous communications from the Hospital de Son Espases in Palma de Mallorca).α-PVP is a substance belonging to the synthetic cathinone group, similar to the phenylalkylamines present in the Catha edulis plant, and like them, they are structurally related to amphetamines. α-PVP is capable of producing sympathomimetic toxicity. Although it has already been seen as a powder to be snorted or as flakka tablets, more recently stashes have been seized in which the substance is harmlessly marketed as “bath salts”.<a class="elsevierStyleCrossRef" href="#bib0045">4</a>The hypothesis that this is a case of chemical submission or vulnerability of flakka and/or benzodiazepines has not been proven. The aforementioned facts are unclear and the flakka concentrations found were extraordinarily low. Chances are that the patient voluntarily sniffed flakka thinking it was cocaine.We also emphasise the importance of having a protocol for possible cases of CS that is recommended by the Commission against Violence from that hospital. Similarly, we value and look forward to continuing collaboration with the INTCF, without which it would not have been possible to detect an unknown, emerging toxic in our context.<a class="elsevierStyleCrossRef" href="#bib0050">5</a> With these improvements in performance and coordination we can provide higher quality care." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Fernández Alonso C, Quintela Jorge O, Santiago Sáez AS. Identificación de la droga de abuso flakka (α-PVP) como sospecha de sumisión química no probada en Urgencias de un hospital terciario. Med Clin (Barc). 2016;147:227–228." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sumisión química: epidemiología y claves para su diagnóstico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Cruz-Landeira" 1 => "O. Quintela-Jorge" 2 => "M. López-Rivadulla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2008" "volumen" => "131" "paginaInicial" => "783" "paginaFinal" => "789" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sumisión química en casos de presuntos delitos contra la libertad sexual analizados en el Instituto Nacional de Toxicología y Ciencias Forenses (Departamento de Madrid) durante los años 2010, 2011 y 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. García-Caballero" 1 => "A. Cruz-Landeira" 2 => "O. Quintela-Jorge" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Med Legal" "fecha" => "2014" "volumen" => "40" "paginaInicial" => "11" "paginaFinal" => "18" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Activación del Código de Intoxicación Aguda Grave (CODITOX) desde la perspectiva hospitalaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Monforte" 1 => "J. Ríos" 2 => "S. Nogué" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2015" "volumen" => "27" "paginaInicial" => "95" "paginaFinal" => "102" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The dangerous new synthetic drug α-PVP as the hydrated chloride salt α-pyrrolidinopentiophenone hydrochloride 0.786-hydrate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Wood" 1 => "I. Bernal" 2 => "R.A. Lalancette" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1107/S2053229615023621" "Revista" => array:6 [ "tituloSerie" => "Acta Crystallogr C Struct Chem" "fecha" => "2016" "volumen" => "72" "paginaInicial" => "48" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26742826" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intoxicaciones por drogas de abuso: sustancias emergentes en el siglo XXI" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Galicia" 1 => "J.R. Alonso" 2 => "S. Nogué" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2014" "volumen" => "26" "paginaInicial" => "472" "paginaFinal" => "480" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack254168" "titulo" => "Acknowledgements" "texto" => "All Accident and Emergency Department professionals, members of the Commission against Violence at the Hospital Clínico San Carlos and INTCF professionals who have collaborated with their effort and dedication." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014700000005/v1_201611300117/S238702061630540X/v1_201611300117/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014700000005/v1_201611300117/S238702061630540X/v1_201611300117/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061630540X?idApp=UINPBA00004N"]

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Vol. 147. Issue 5.

Pages 227-228 (September 2016)

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