THE AGONY AND THE ECSTASY THE HAZARDS OF DESIGNER DRUGS by mikesanye

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									   AN EMERGENCY
    DEPARTMENT
PERSPECTIVE ON THE
 HAZARDS OF PARTY
       DRUGS
        Venita Munir
       Staff Specialist
   Emergency Department
    St Vincent’s Hospital
    ST VINCENT’S EXPERIENCE
       WITH PARTY DRUGS
Party Drug Overdose or Adverse Reactions
  December 2002 - June 2003
   – 103 presentations so far flagged
   – Ecstasy, GHB, Amphetamine, Ice, Cocaine,
      Ketamine
   – 63 male, 41 female
   – Most frequent primary drug taken
       • Ecstasy 43%
       • GHB 24%
       • Amphetamines including Ice 25%
                                      (Preliminary data only)
 ST VINCENT’S EXPERIENCE
    WITH PARTY DRUGS
– 43% took one drug only
– Alcohol involved in 25%
– Excluding alcohol:
   • 37% took 2 drugs
   • 8% took 3 drugs
   • 3% took 4 drugs
                            (Preliminary data only)
      Presenting Symptoms
          (in order of frequency)
•   Altered conscious state 43%
•   Chest pain/ Palpitations 10%
•   Agitation/ Bizarre Behaviour 8%
•   Psychiatric disturbance 7%
•   Headache 5%
•   Seizure 5%
•   Shortness of breath 5%
•   Injuries 5%
•   Vomiting 3%
                                      (Preliminary results only)
CASE 1 - HISTORY

•   DH 26 y.o. male BIBA 5:30a.m.
•   Took “a few E’s” last night
•   Noted to drink a lot of water
•   Deteriorating conscious state
•   Vomit x1
•   Seizure 60-90 seconds
•   Small amount alcohol, no other drugs
•   No history of epilepsy
• EXAMINATION FINDINGS
  –   Breathing but required nasal airway
  –   Pulse 80, BP normal
  –   Opening eyes to pain, groaning
  –   Agitated, requiring physical restraint
  –   Pupils large

• INVESTIGATIONS
  –   Blood sugar normal
  –   Low sodium 114 (normal 135-145)
  –   Muscle enzyme CK high 4066        (normal up to 200)

  –   CT Brain – normal
MANAGEMENT
Provisional Diagnosis:
    Ecstasy induced hyponatraemia (low sodium)
    resulting in seizure & muscle breakdown

•   Neurological observation
•   Sedation
•   Sodium slowly replaced IV over 36 hours
•   Neurological improvement over 24 hours
•   Discharged home at 48 hours
•   Referral for Drug and Alcohol Counselling
    ECSTASY - SIDE EFFECTS

•   Anorexia, nausea, vomiting, dry mouth
•   Palpitations, hypertension
•   Sweating
•   Insomnia, anxiety, agitation
•   Muscle pain & stiffness, tooth grinding
•   Large pupils
     ECSTASY - PROBLEMS
• Hyperthermic syndrome (high temperature
  resulting in coma & kidney failure)
• Hyponatraemia (low sodium resulting in
  confusion & seizures)
• Overdose
   – Seizures, confusion, cardiac problems
• Impurities with toxic side effects (eg:PMA)
• Long term
   – liver abnormalities, depression, psychosis
        PROBLEMS OF OTHER
          AMPHETAMINES
• Acute toxicity
   – Agitation
   – Palpitations, hypertension
   – Rare – strokes or cardiac problems
• Prolonged use:
   – Paranoia, anxiety, depression
   – Withdrawal syndrome
   – Psychosis
   – Hypertension
   – Complications of IVDU
CASE 2 - HISTORY


• MW 18 y.o. male BIBA seen to collapse
  outside nightclub
• Had taken 2 Ecstasy tablets plus
  unknown amount of GHB
• Vomit x1
• No alcohol
• No trauma
• No significant past history
• EXAMINATION
 –   Breathing but required oral airway
 –   Pulse 75, BP 96/76
 –   No eye opening, no vocal response
 –   Pupils dilated
 –   No injuries or other abnormalities

• INVESTIGATIONS
 –   Blood sugar 5.6
 –   ECG & All bloods - normal
 –   Alcohol <0.01
 –   CXR normal
MANAGEMENT
•   Nursed on his side
•   O2, IV fluids
•   Observed 15 min - no change conscious state
•   Attempted intubation (airway protection)
•   Vomited, abruptly sat up, awoke, mumbling
•   Remained very drowsy
•   No further attempt to intubate
•   Slow improvement over 3.5 hours
•   Discharged with relatives at 4 hours
GHB Side Effects & Overdose

 – Disinhibition
 – Dizziness, blurred vision, hot/cold flushes
 – Marked nausea & vomiting
 – Muscle spasm & abnormal movements
 – Disorientation, seizures
 – Abrupt loss of consciousness
 – Coma
 – Cardiac & respiratory depression
        KETAMINE EFFECTS
• Desired effects
  – Euphoria,
  – “Out-of-body” or “near-death” experience
  – Hallucinations, vivid dreams
  – Floating sensation

• Adverse effects & Overdose
   – Loss of self control, high risk of injury
   – Amnesia, confusion, hostility
   – Cardiac & respiratory depression
   ADVERSE EFFECTS OF
        COCAINE
– Palpitations
– Hypertension
– Sweating, high temp, dilated pupils
– Loss of judgement
– Accelerated heart disease - 7 x incidence
  heart attacks
– Strokes, brain haemorrhages
– Sudden death
– Tolerance & withdrawal - mood crash,
  dysphoria, craving, depression, paranoia
Summary–an ED Perspective
• Party Drug related overdose and adverse effects
  have been increasing in ED presentations
  especially on weekends and public holidays
• We are unsure what % of users are presenting
  with these problems
• Whilst not many admitted, there are still many
  life threatening problems, especially coma,
  respiratory depression, and seizures
• A small number require Intensive Care treatment
• We have not seen any deaths so far in our ED
• They place significant demands on the ED in the
  need for very close observation until recovery
  (not always necessitating hospital admission)
They are not as safe as
  commonly thought!

      THE END

								
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