Over a century since ephedrine discovery: an updated revisit to its pharmacological aspects, functionality and toxicity in comparison to its herbal extracts

Ephedrine, a sympathomimetic amine that exhibits several of adrenaline actions, is a plant alkaloid that is a common ingredient in several cold, asthma and narcolepsy treatment preparations, and in obesity...

106 Haemorrhagic spinal cord infarct – a rare complication of sympathomimetic amine toxicity

IntroductionSympathomimetic amines are recreational substances, available illegally as amphetamine derivatives (eg, ‘ecstasy’ and ‘speed’). Ingestion can lead to significant medical complications such as hyperthermia, tachyarrhythmia, seizures and strokes, attributed to catecholamine surge and sympathetic overstimulation.MethodWe report an unusual case of sympathomimetic amine ingestion manifesting as hypertension followed by acute onset flaccid paralysis of lower limbs bilaterally and T11 level anaesthesia in a 64 year old woman secondary to haemorrhagic cord infarct.ResultsAn MRI spine showed features compatible with spinal cord infarction from thoracic level 6/7 to conus associated with cord haemorrhage. There was no evidence of vascular malformations on imaging and the screen for inflammatory myelitides was negative. A urine drug screen tested positive for sympathomimetic amines and the patient acknowledged ingesting a pill of ‘unknown identity’.ConclusionThis case highlights a previously unreported complication of recreational sympathomimetics associated with significant patient morbidity. Unfortunately, this woman failed to make significant improvements during admission with ongoing severe motor and sensory deficits of her lower limbs.

Study on Forms of Intoxication with Cocaine and Evolutionary Aspects

Cocaine is an alkaloid obtained from the leaves of the coca plant, Erythroxylum coca. Cocaine sulfate, a brown paste, is obtained from coca leaves and from this, cocaine hydrochloride, a white substance, soluble in water and with a bitter taste that may be in the form of white crystals or powder. From cocaine hydrochloride crack is obtained by heating, a more purified form and with greater power of intoxication and addiction. Once in the organism, cocaine behaves like an indirect sympathomimetic amine and produces a blockade of the presynaptic reuptake of dopamine, adrenaline, noradrenaline and serotonin, thus increasing their levels. At the cardiovascular level cocaine is responsible for malignant arrhythmias, sometimes responsible for sudden death. Other symptoms that can occur are aortic dissection, arterial hypertension and coronary vasoconstriction able to trigger an acute myocardial infarction. The authors present a case of sudden cardiac death due to cocaine intoxication in a young male without any cardiac risk factors. The autopsy, together with the results of the complementary tests, indicate that the most probable death mechanism has been a cardiogenic shock secondary to extensive myocardial necrosis due to cocaine intoxication.