Q: Five college students are brought to ER after a dorm's 'crazy monkey' party with multiple symptoms including tachycardia, psychosis and slurred speech. Rapid urine drug screen is negative for cannabinoids for all patients. What is your probable diagnosis?
Answer: Synthetic cannabinoid toxicity
Unfortunately synthetic cannabinoid (a misnomer) is a widely available and abused drug during parties. Various street names are K2, spice, crazy monkey, chill out, spice diamond, spice gold, and chill X. Rapid urine drug screens can not detect synthetic cannabinoids. It requires time consuming liquid chromatography and mass spectrometry tests.
There is no antidote and management is symptomatic treatment for tachycardia, hyperthermia, rhabdomyolysis, chest pain, pneumothorax, stroke or kidney failure. Benzodiazepines may be helpful.
#toxicology
References:
1. Kuehn B. Synthetic Cannabidiol Poisoning. JAMA 2018; 319:2264.
2. Mills B, Yepes A, Nugent K. Synthetic Cannabinoids. Am J Med Sci. 2015 Jul;350(1):59-62. doi: 10.1097/MAJ.0000000000000466. PMID: 26132518.
3. Darke S, Banister S, Farrell M, Duflou J, Lappin J. 'Synthetic cannabis': A dangerous misnomer. Int J Drug Policy. 2021 Dec;98:103396. doi: 10.1016/j.drugpo.2021.103396. Epub 2021 Jul 31. PMID: 34343944.
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