Clinical Pathology: Clinical Chemistry

• There has been a recent surge in the sale, consumption, and abuse of synthetic stimulants packaged and sold as bath salts, which have been found to contain the stimulant compound mephedrone (i.e., 4-methyl-methcathinone).

• Mephedrone is among several synthetic derivatives of cathinones, a Schedule I stimulant substance found in the khat plant grown in east Africa.

• These β-keto analogs of amphetamines share psychoactive properties similar to cocaine, amphetamines, and methylenedioxymethamphetamine (MDMA) and are known to produce a profound deliriogenic toxidrome, generating intense agitation and hallucinations.

• The β-keto analogs are not detected by routine assays that screen for amphetamines. However, they may possibly cause a false-positive test result for phencyclidine (PCP).

• Gas chromatography–mass spectrometry (GC/MS) and liquid chromatography–tandem mass spectrometry (LC/MS-MS) assays have been described that identify synthetic derivatives of cathinones.

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