Intoxication Delirium following Use of Synthetic Cathinone Derivatives

Background: In published reports of hallucinatory delirium following use of bath salts analytic laboratory testing has demonstrated the synthetic cathinone derivative methylenedioxypyrovalerone (MDPV). MDPV can cause a false-positive screening immunoassay result for phencyclidine (PCP). Patients using MDPV are prone to development of the syndrome of excited delirium (ExD), a condition also described with PCP. Objective: This review summarize reports from several series of cases of delirium associated with MDPV emphasizing the features of both intoxication and excited delirium. Methods: Literature review and clinical description of a series of patients from Eastern North Carolina. Conclusion: MDPV is likely the responsible agent in production of both toxic and excited delirium syndromes identified with the recreational use of bath salts in the United States over the past two years. Scientific significance: Patients using MDPV are prone to the development of toxic delirum with some developing ExD. a condition associated with considerable risk for serious medical morbidity. Commonly used interventions directed at extreme agitation and paranoia may exacerbate the pathophysiology of ExD.