Abstract
Background
Although hyperthermia is described after cocaine intoxication, the two hyperthermic
cases discussed were unusual in severity and duration for cocaine alone. Synephrine
was found in biological samples of these patients in high concentrations and was suspected
to be an adulterant in illicitly obtained drugs.
Case Report
Two patients presented to a tertiary care university hospital within 2 days of each
other after recreational drug use with delayed and protracted hyperthermia. Synephrine
was later found in high concentrations in biological samples as an unexpected drug
adulterant. The first patient's presentation came with delayed recognition of hyperthermia
and implementation of aggressive cooling measures; he entered multisystem organ failure
with prolonged intensive care unit stay and significant morbidity. The second patient's
hyperthermia was recognized promptly, and she received early, aggressive cooling,
including deep sedation and ice water submersion. She left against medical advice
from the hospital at her baseline 3 days after presentation.
Why Should an Emergency Physician Be Aware of This?
Synephrine is a suspected adulterant that may be associated with profound hyperthermia.
Early recognition of drug overdose and working knowledge of common adulterants can
facilitate early targeted management, such as aggressive cooling measures, which may
prevent morbidity and mortality.
Keywords
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Article info
Publication history
Published online: November 12, 2022
Accepted:
November 6,
2022
Received in revised form:
September 27,
2022
Received:
June 13,
2022
Footnotes
RECEIVED: 13 June 2022; FINAL SUBMISSION RECEIVED: 27 September 2022; ACCEPTED: 6 November 2022
Identification
Copyright
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