Survival Despite Severe Hyperthermia and Multi-Organ System Dysfunction Following Week-Long Use of an MDPV Containing "Stain Remover"

Abstract

Synthetic amphetamine and cathinone analogs are sympathomimetic hallucinogens that can cause significant toxicity. Hyperthermia in the setting of sympathomimetic overdose is typically associated with a high mortality. We report a case of neurologically intact survival after extreme hyperthermia in the setting of a sympathomimetic overdose. A 29 year-old male ingested a methylenedioxypyrovalerone "stain remover" and exhibited excited delirium and severe sympathomimetic effects. Multi-organ system toxicity included severe hyperthermia, acidosis, hypoglycemia, intracranial hemorrhage, status epilepticus, myocardial infarction, hypotension, rhabdomyolysis, acute renal failure, acute hepatic injury, and coagulopathy. With aggressive cooling, intravenous fluids, benzodiazepine use, peripheral vasopressors, and hemodialysis, he had a good neurologic outcome at the time of discharge after a 17-day hospital course. Despite a high mortality rate with severe hyperthermia, this case suggests that patients with toxin-induced multi-system organ dysfunctionand associated hyperthermia may recover with early aggressive supportive care.