The khat plant is native to the Horn of Africa and Arabian peninsula. Its leaves contain cathinone, an amphetamine-like alkaloid. For centuries, inhabitants of the plant's native area have chewed the leaves for a mild euphoriant and stimulant effect. In those regions, chewing khat is often a social activity, similar to coffee drinking in other societies. Recently, khat use has spread to other countries and more recently a number of derivatives of the base alkaloid have been synthesized and become drugs of abuse.
Derivatives include the drugs known as bath salts, often containing the substituted cathinones mephedrone or methylenedioxypyrovalerone. However, the actual structures change frequently. The products have been termed "bath salts" and labeled "not for human consumption" to avoid legal challenge. Reported use of substituted cathinones increased several thousand-fold from 2010 to 2011, and worldwide seizure of related compounds by drug enforcement authorities has increased significantly in early 2017 over the similar time period in 2016.
The physiologic effects of the substituted cathinones are similar to those of amphetamines and include the potential to cause myocardial infarction, rhabdomyolysis, renal failure, and liver failure. However, the exact mechanism responsible for organ damage is unknown.
Patients may present with headache, tachycardia and palpitations, hallucinations, agitation, an increased endurance and tolerance for pain, and propensity for violent behavior.
Diagnosis is made by clinical evaluation; substituted cathinones are not detected with routine urine or blood testing. Patients with severe acute intoxication should typically have blood tests (complete blood count, electrolytes, blood urea nitrogen, creatinine, creatine kinase), urine testing for myoglobinuria, and ECG.
Sedation with IV benzodiazepines, IV fluids, and supportive care are typically adequate. Patients with hyperthermia, persistent tachycardia or agitation, and elevated serum creatinine should be admitted for further monitoring for rhabdomyolysis and cardiac and renal injury.