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Citation |
Armstrong F, McCurdy MT, Heavner MS. Pharmacotherapy 2019; 39(4): 508-513. |
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Affiliation |
Department of Pharmacy Practice and Science, University of Maryland, School of Pharmacy. |
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Copyright |
(Copyright © 2019, Pharmacotherapy Publications) |
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DOI |
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PMID |
30811628 |
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Abstract |
Over the past decade, use of synthetic cannabinoids (also known as "K2″ and "spice") has grown in popularity nationwide. We describe a multicenter series of six patients admitted with synthetic cannabinoid intoxication displaying similar symptoms and sequelae, all resulting in multiple organ failure. All patients presented with altered mental status and severe rhabdomyolysis, with a peak creatine phosphokinase (CPK) ranging from 4,000 to >320,000 units/L. The majority of patients (5/6) presented with acute kidney injury (AKI), with most (4/6) requiring continuous renal replacement therapy. Most patients experienced fever (5/6) and myocardial injury, as evidenced by a troponin elevation (3/6). Seizures occurred in half of patients (3/6 patients). Two patients required emergent fasciotomies of the bilateral lower extremities for acute compartment syndrome. Two patients developed fulminant hepatic failure that necessitated liver transplant evaluation, one requiring molecular adsorbent recirculating system (MARS® ) therapy as a bridge to successful transplant, while the one without it did not survive. Delirium, severe rhabdomyolysis, AKI, and fever are common in patients with synthetic cannabinoid intoxication. Given the growing abuse of these substances, clinicians should consider their use in the differential of such patient presentations. To our knowledge, only a few published case reports discuss multiple organ failure associated with synthetic cannabinoid toxicity, and only two have described an associated acute liver failure (ALF). Our report describes the first case of SC-associated ALF requiring organ transplantation. Clinicians should be aware of life-threatening complications and consider SC ingestion in the differential diagnosis of patients presenting with multiple organ failure. This article is protected by copyright. All rights reserved. Language: en |
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Keywords |
acute kidney injury; acute liver failure; cannabinoids; multiple organ failure; rhabdomyolysis |