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ingestion are the most common routes of administration, though inhalation, IV/IM use, and rectal administration have also been described Cathinones are β-ketophenethylamines, structurally similar to amphetamines The primarily pharmacologic mechanism of action is via blocking the reuptake of dopamine, norepinephrine, and serotonin Onset of action is typically rapid, though pharmacokinetics vary depending on the particular derivative and route of administration Clinical Considerations Amphetamine-like sympathomimetic effects predominate Desired effects include a sense of euphoria, increased energy, enhanced openness, and empathy The most common clinical findings include agitation, aggression, hallucinations, tachycardia, hypertension, mydriasis, and hyperthermia Adverse effects reported by users include palpitations, chest pain, dry mouth, nausea, and vomiting Severe sequelae of use include seizures, myocardial infarction, myocarditis, rhabdomyolysis, excited delirium syndrome, serotonin syndrome, and death As with many ingestions, the presence of hyperthermia is typically a poor prognostic indicator Treatment is primarily supportive, with initial attention often directed to management of agitation, aggression, tachycardia, hypertension, and hyperthermia with liberal use of IV benzodiazepines A core temperature should be obtained While benzodiazepines may effectively manage hyperthermia, consider passive or active cooling techniques if hyperthermia persists Further testing often includes an EKG, electrolytes, renal function, hepatic transaminases, and a CK Standard drug screens for amphetamines are often negative in the setting of synthetic cathinone use Administer IV fluids, particularly in the setting of rhabdomyolysis Suggested Readings and Key References Reference Toxicology Textbooks Erickson T, Ahrens W, Aks S, et al., eds Pediatric Toxicology: Diagnosis and Management of the Poisoned Child New York: McGraw-Hill; 2005 Nelson LS, Howland MA, Lewin NA, et al., eds Goldfrank’s Toxicologic Emergencies 11th ed New York: McGraw-Hill; 2019 Osterhoudt KC, Perrone J, DeRoos F, et al Toxicology Pearls Philadelphia, PA: Hanley & Belfus; 2004