How High Do They Look?

Abstract and Introduction

Abstract

Adolescents have access to a variety of legal or illicit substances that they use to alter their mood or "get high." The purpose of this review is to provide an overview of common substances adolescents use to get high, including the illicit substances synthetic marijuana or "Spice," salvia, MDMA, synthetic cathinones, and 2C-E. Dextromethorphan and energy drinks are easily accessible substances that teenagers abuse. The toxic effects of common ingestions and treatment of overdose is discussed to inform pediatric providers who provide care for adolescents.

Introduction

A 15-year-old girl presents to Urgent Care, saying that she has had persistent vomiting for the past 4 hours. She also reports seeing double, that colors are too bright, and that she has a headache. Her parent notes that she appeared confused and was knocking things over when she tried to reach for them after arriving home from school today. Significant examination findings include heart rate, 120 beats per minute; blood pressure, 146/96 mm Hg; and pupils, 5 mm equal, with a sluggish reaction to light. A few subconjunctival hemorrhages are noted bilaterally, although the fundi are benign. Her breath has no unusual odor. Epigastric tenderness is appreciated with hypoactive bowel sounds. Muscular abdominal wall tenderness is present from her xiphoid to pubis along the rectus. Allodynia upon palpation of her face, extremities, and trunk is noted. Her mental status examination reveals that she is anxious and confused. She repeatedly looks at her parent and asks, "Who are you?" She has emotional lability, with inappropriate episodes of hysterical laughter. The patient is unable to perform basic cognitive tests accurately; however, she is able to respond appropriately to questions with a significant delay in response. Her blood glucose level is 110 mg/dl, and results of a urine drug screen are negative. This patient subsequently is found to have a packet of potpourri in her purse and admits that she smoked it with a friend on the way home from school. The package label identifies the ingredients as CP-47.

Table 1. Common substances adolescents ingest, signs of toxicity, and treatment
Name	Street name	How ingested	Clinical presentation of toxicity	Treatment
Synthetic cannabinoid receptor agonists	Spice, K2	Smoked	Agitation, anxiety, paranoia, tachycardia, hypertension, muscle spasms, seizures, tremors, psychosis	Benzodiazepines (lorazepam) for agitation and seizures; EEG if seizures; serial cardiac enzymes if chest pain; psychiatric consult should be considered
Salvia	Maria Pastora, Sage of the Seers, Diviner's Sage, Sally-D, Magic Mint	Chewed, smoked	Hallucinations, incoordination, slurred speech	Supportive care; effects usually last up to 3 hours
3,4-Methylenedioxy-methamphetamine (MDMA)	Ecstasy, MDMA, XTC, E, X, Beans, Adams	Oral	Confusion, anxiety, depression, paranoia, involuntary teeth clenching, hyperthermia, hypertension, loss of consciousness, seizures	ABCs: oxygen, IV fluids, cardiac monitoring; neurologic assessment, monitor glucose, electrolytes, liver function and temperature; urine toxicology; CPK and myoglobin levels; treat hyperthermia by undressing patient, evaporative cooling with fan and water, ice packs to groin and axilla; treat seizures with benzodiazepines
Synthetic cathinone stimulantsMephedroneMethylenedioxy-pyrovalerone (MDPV)	Bath salts, Bliss, Blue Silk, Meow Meow, White Dove, Pure Ivory	Sniffing/snortingInjectionRectal	Agitation, insomnia, irritability, dizziness, depression, paranoia, delusions, seizures, panic attacks	IV fluids and benzodiazepines
Dextromethorphan	DXM, Skittles, Robo, Robotripping, Poor man's PCP	Oral	Nausea and vomiting, nystagmus, dilated pupils, body itching, rash, ataxia, sweating, hot/cold flashes, fever, hypertension, shallow respiration, urinary retention, diarrhea, opisthotonos, tachycardia, hyperthermia, toxic psychosis, and coma	Administer charcoal if less than 1 hour since ingestion; naloxone may be administered for sedation and coma; evaluate for toxic effects of co-administered drugs
2C-E (4-ethyl-2,5-dimethoxyphenethylamine)	Europa	Oral or nasal	Hallucinations; little is known	Supportive care
Energy drinksCaffeine and supplements	Monster, AMP, Rockstar, Red Bull, Full Throttle, 5-Hour Energy Shot, Vault	Oral	Vomiting, tachycardia, altered mental status, seizures, dysrhythmias, hypotension, hyperglycemia, hyperkalemia, death	Charcoal gastric decontamination if < 1 hour from ingestion; IV fluids; ondansetron for vomiting; benzodiazepines for CNS excitation or seizures; hemodialysis if necessary

Table 1. Common substances adolescents ingest, signs of toxicity, and treatment

Name

Street name

How ingested

Clinical presentation of toxicity

Treatment

Synthetic cannabinoid receptor agonists

Spice, K2

Smoked

Agitation, anxiety, paranoia, tachycardia, hypertension, muscle spasms, seizures, tremors, psychosis

Benzodiazepines (lorazepam) for agitation and seizures; EEG if seizures; serial cardiac enzymes if chest pain; psychiatric consult should be considered

Salvia

Maria Pastora, Sage of the Seers, Diviner's Sage, Sally-D, Magic Mint

Chewed, smoked

Hallucinations, incoordination, slurred speech

Supportive care; effects usually last up to 3 hours

3,4-Methylenedioxy-methamphetamine (MDMA)

Ecstasy, MDMA, XTC, E, X, Beans, Adams

Oral

Confusion, anxiety, depression, paranoia, involuntary teeth clenching, hyperthermia, hypertension, loss of consciousness, seizures

ABCs: oxygen, IV fluids, cardiac monitoring; neurologic assessment, monitor glucose, electrolytes, liver function and temperature; urine toxicology; CPK and myoglobin levels; treat hyperthermia by undressing patient, evaporative cooling with fan and water, ice packs to groin and axilla; treat seizures with benzodiazepines

Synthetic cathinone stimulantsMephedroneMethylenedioxy-pyrovalerone (MDPV)

Bath salts, Bliss, Blue Silk, Meow Meow, White Dove, Pure Ivory

Sniffing/snortingInjectionRectal

Agitation, insomnia, irritability, dizziness, depression, paranoia, delusions, seizures, panic attacks

IV fluids and benzodiazepines

Dextromethorphan

DXM, Skittles, Robo, Robotripping, Poor man's PCP

Oral

Nausea and vomiting, nystagmus, dilated pupils, body itching, rash, ataxia, sweating, hot/cold flashes, fever, hypertension, shallow respiration, urinary retention, diarrhea, opisthotonos, tachycardia, hyperthermia, toxic psychosis, and coma

Administer charcoal if less than 1 hour since ingestion; naloxone may be administered for sedation and coma; evaluate for toxic effects of co-administered drugs

2C-E (4-ethyl-2,5-dimethoxyphenethylamine)

Europa

Oral or nasal

Hallucinations; little is known

Supportive care

Energy drinksCaffeine and supplements

Monster, AMP, Rockstar, Red Bull, Full Throttle, 5-Hour Energy Shot, Vault

Oral

Vomiting, tachycardia, altered mental status, seizures, dysrhythmias, hypotension, hyperglycemia, hyperkalemia, death

Charcoal gastric decontamination if < 1 hour from ingestion; IV fluids; ondansetron for vomiting; benzodiazepines for CNS excitation or seizures; hemodialysis if necessary

Plateau	Dose (mg)	Behavioral effects
1	100–200	Mild stimulation
2	200–400	Euphoria and hallucinations
3	300–600	Distorted visual perceptionsLoss of motor coordination
4	500–1500	Dissociative sedation

"How High Do They Look?"

Identification and Treatment of Common Ingestions in Adolescents

Abstract and Introduction

Abstract

Introduction

"How High Do They Look?"

Identification and Treatment of Common Ingestions in Adolescents

Abstract and Introduction

Abstract

Introduction

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

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