Pediatric emergency medicine trisk 3163 3163

Because inhalant abuse may lead to the development of life-threatening
symptoms, close attention should be directed to the stability of vital signs over
time. Patients with depressed levels of consciousness may require airway support
and ventilation. Because of the risk of cardiac arrhythmias when halogenated
hydrocarbons are abused, vascular access should be established early.
Dysrhythmias should be treated according to the standard protocol; however, the
use of epinephrine is relatively contraindicated because it may worsen rhythm
disturbances. As a part of the evaluation, obtain a complete metabolic panel that
includes electrolyte levels, with calcium, phosphate, and magnesium; amylase
level; liver function tests; creatine phosphokinase level; and urinalysis. Treatment
of methemoglobinemia is discussed in Chapter 93 Hematologic Emergencies .

OTHER EMERGING DRUGS OF ABUSE
Current Evidence
In recent years, use of the so-called “designer drugs” or synthetic drugs of abuse
has markedly increased, in part due to the fact that many of these substances were
originally sold at head shops, convenience stores, and over the internet as “legal
highs.” The Synthetic Drug Abuse Prevention Act of 2012 placed many of the
most commonly identified compounds into Schedule I status, though new
derivatives and formulations continue to be produced and distributed. Staying up
to date with these emerging substances of abuse can be challenging for providers.
Your local poison control center and public health department can be helpful
resources when caring for a patient with possible exposure to one of these agents.
Given their particular popularity, the synthetic cathinones are described in further
detail below, and synthetic cannabinoids in the section on cannabis. Other
important classes of these so-called designer drugs include the 2C class of drugs
(phenylethylamine derivatives with sympathomimetic, hallucinogenic, and
serotonergic features) and piperazines (sympathomimetic features predominate).

Cathinones
Cathinones are naturally occurring substances found in the leaves of the khat

(Catha edulis) plant. For centuries, people have chewed the leaves of this plant
for the euphoric and stimulant effects. Synthetic cathinone derivatives were first
synthesized in the 1920s, but use among recreational drug users noticeably
escalated in 2010–2011. These substances were initially sold as bath salts or plant
food and labeled as “not for human consumption.” Nasal insufflation and