Table 4.
Demographic, clinical, and laboratory characteristics of 119 case patients with reported synthetic cannabinoid-associated illness by synthetic cannabinoid test results—University of Mississippi medical center (UMMC), April 2–May 3, 2015.
| Characteristic | Total (%) n = 119 | Total tested for SCs (%), n = 56 | SC positive (%), n = 39 | MAB positive (%), n = 33 |
|---|---|---|---|---|
|
| ||||
| Male sex | 101 (85) | 45 (80) | 30 (77) | 26 (79) |
| Median age, years (IQR) | 29 (23–36) | 29 (23.5–36.5) | 31 (23–38) | 25.5 (21–36) |
| Past medical history | ||||
| High blood pressure | 16 (13) | 8 (14) | 6 (15) | 5 (15) |
| Seizure disorder | 7 (6) | 4 (7) | 2 (5) | 2 (6) |
| Mental illness | 32 (27) | 18 (32) | 12 (31) | 9 (27) |
| Substance abuse | 37 (31) | 17 (30) | 12 (31) | 10 (30) |
| Mental status reported before medication administrationa | ||||
| Violent/aggressive behavior | 38 (32) | 18 (32) | 12 (31) | 12 (36) |
| Agitation | 36 (30) | 17 (31) | 11 (28) | 10 (30) |
| Confusion | 30 (25) | 13 (23) | 9 (23) | 8 (24) |
| Somnolence | 24 (20) | 8 (14) | 8 (21) | 8 (24) |
| Unresponsiveness | 19 (16) | 10 (18) | 8 (21) | 7 (21) |
| Anxiety | 16 (13) | 10 (18) | 7 (18) | 6 (18) |
| Hallucinations | 10 (8) | 4 (7) | 3 (8) | 1 (3) |
| Seizures | 8 (7) | 3 (5) | 3 (8) | 3 (9) |
| Psychosis | 6 (5) | 2 (4) | 1 (3) | 1 (3) |
| Paranoia | 2 (2) | 1 (2) | 0 | 0 |
| Initial vital signs | ||||
| Systolic blood pressure ≤90 mmHg | 9/115 (8) | 5/53 (9) | 5/37 (14) | 5/32 (16) |
| Systolic blood pressure ≥140 mmHg | 38/115 (33) | 19/53 (36) | 11/37 (30) | 9/32 (28) |
| Heart rate ≥100 beats per minute | 48/115 (42) | 16/54 (30) | 16/37 (43) | 13/32 (41) |
| Heart rate ≤60 beats per minute | 9/115 (8) | 5/54 (9) | 4/37 (11) | 4/32 (13) |
| Respiratory rate >20 breaths/minute | 25/113 (22) | 13/52 (25) | 11/37 (30) | 10/32 (31) |
| Oxygen saturation <90% | 5/112 (5) | 3/53 (6) | 2/36 (6) | 2/31 (6) |
| Initial physical examination findings | ||||
| Diaphoresis | 8 (7) | 3 (5) | 2 (5) | 1 (3) |
| Dilated pupils | 11 (9) | 6 (11) | 5 (13) | 5 (15) |
| Nonreactive, minimally reactive, or sluggish pupils | 13 (11) | 7 (13) | 6 (15) | 6 (18) |
| Tachycardia | 25 (21) | 11 (20) | 8 (21) | 8 (24) |
| Bradycardia | 3 (3) | 1 (2) | 1 (3) | 1 (3) |
| Altered mental statusb | 58 (49) | 25 (45) | 20 (51) | 19 (58) |
| Clinical laboratory result abnormalities (abnormal/tested) | ||||
| Hyponatremia (serum sodium <135 mEq/L) | 2/97 (2) | 9/49 (18) | 2/33 (6) | 2/31 (6) |
| Hypernatremia (serum sodium >145 mEq/L) | 5/97 (5) | 1/49 (2) | 1/33 (3) | 1/31 (3) |
| Hypokalemia (serum potassium <3.5mEq/L) | 16/97 (16) | 9/49 (18) | 6/33 (18) | 6/31 (19) |
| Hyperkalemia (serum potassium >5.0 mEq/L) | 5/97 (5) | 4/49 (8) | 4/33 (12) | 3/31 (10) |
| High serum creatinine (serum creatinine ≥1.5 mg/dL) | 13/97 (13) | 7/49 (14) | 5/33 (15) | 5/31 (16) |
| Hyperglycemia (glucose >140 mg/dL) | 17/95 (18) | 11/48 | 10/33 (30) | 10/31 (32) |
| Hypoglycemia (glucose <70 mg/dL) | 6/95 (6) | 1/48 (23) | 0 | 0 |
| Elevated serum creatinine kinase (CK) | ||||
| Creatinine kinase ≥150 units/L | 64/77 (83) | 32/37 (86) | 22/26 (85) | 21/25 (84) |
| Creatinine kinase ≥1000 units/L | 14/77 (18) | 9/37 (24) | 4/26 (15) | 3/25 (12) |
| Clinical drug testing (% positive/tested) | ||||
| Benzodiazepines | 12/89 (13) | 6/43 (14) | 4/34 (12) | 4/32 (13) |
| Amphetamines | 6/89 (7) | 2/43 (5) | 1/34 (3) | 1/32 (3) |
| Cocaine | 19/89 (21) | 9/43 (21) | 7/34 (21) | 7/32 (22) |
| Cannabinoids | 60/89 (67) | 32/43 (74) | 25/34 (74) | 24/32 (75) |
| Ethanol | 11/49 (22) | 4/26 (15) | 3/20 (15) | 2/19 (11) |
| Any positive drug screen | 69/93 (74) | 35/43 (81) | 28/34 (82) | 27/32 (84) |
| Interventions | ||||
| Intubation | 12 (10) | 7 (13) | 7 (18) | 6 (18) |
| Cardiopulmonary resuscitation | 2 (2) | 2 (4) | 2 (5) | 1 (3) |
| Hemodialysis | 1 (1) | 1 (2) | 1 (3) | 1 (3) |
| Benzodiazepine administration | 33 (28) | 20 (36) | 14 (36) | 12 (36) |
| Antipsychotic administration | 23 (19) | 13 (23) | 8 (21) | 7 (21) |
| Naloxone administration | 8 (7) | 5 (9) | 3 (8) | 2 (6) |
| Highest level of care received and disposition | ||||
| Discharged from the emergency department | 88 (74) | 37 (66) | 26 (67) | 22 (67) |
| Left against medical advice | 9 (8) | 4 (7) | 0 | 0 |
| Admitted to general inpatient service | 13 (11) | 9 (16) | 6 (15) | 5 (15) |
| Admitted to intensive care unit | 12 (10) | 7 (13) | 7 (18) | 7 (21) |
| Death | 2 (2) | 1 (2) | 1 (3) | 0 |
CI: confidence interval; IQR: interquartile range; SC: synthetic cannabinoid; MAB-CHMINACA: (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-indazole-3-carboxamide.
a
The odds ratio of any reported pre-medication change in mental status between those testing positive for MAB-CHMINACA versus those who did not was 3.8 (95% confidence interval: 1.1–14.8, p = .02).
b
The odds ratio of documented altered mental status noted on physical exam between those testing positive for MAB-CHMINACA versus those who did not was 3.3, (95% confidence interval: 1.0–11.7, p = .05).