Salvia toxicity: Difference between revisions
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==Background== | |||
[[File:Salvia.jpg|thumb|Salvia divinorum]] | |||
*Historically used by shamans in rituals | *Historically used by shamans in rituals | ||
*Active ingredient: Salvinorin A | *Active ingredient: Salvinorin A | ||
*Kappa | *Kappa opioid receptor agonist and D2 agonist | ||
*Hallucinogen | *Hallucinogen | ||
*Dissociative effects similar to ketamine | *Dissociative effects similar to ketamine | ||
*Tea: 10 min onset, duration 30-90 min | *Tea: 10 min onset, duration 30-90 min | ||
*Smoked: 1-2 minute onset, tapers over 10-20 min | *Smoked: 1-2 minute onset, tapers over 10-20 min and may last up to 1-2 hours | ||
*Does not appear on typical tox screens | *Does not appear on typical tox screens | ||
==Clinical Features== | |||
*Uncontrollable laughter | *Uncontrollable laughter | ||
*Intense hallucinations | *Intense hallucinations | ||
| Line 19: | Line 18: | ||
*Few reports of psychosis and suicide associated with use | *Few reports of psychosis and suicide associated with use | ||
==Differential Diagnosis== | |||
{{Hallucinogen types}} | |||
==Management== | |||
*Supportive | *Supportive | ||
*Benzodiazepines as needed | *[[Benzodiazepines]] as needed | ||
*Most patients will have symptoms resolve prior to ED | *Most patients will have symptoms resolve prior to ED arrival given short duration of action | ||
==See Also== | |||
*[[Hallucinogens]] | |||
[[Category: | ==References== | ||
<references/> | |||
[[Category:Toxicology]] | |||
Latest revision as of 01:13, 24 July 2017
Background
- Historically used by shamans in rituals
- Active ingredient: Salvinorin A
- Kappa opioid receptor agonist and D2 agonist
- Hallucinogen
- Dissociative effects similar to ketamine
- Tea: 10 min onset, duration 30-90 min
- Smoked: 1-2 minute onset, tapers over 10-20 min and may last up to 1-2 hours
- Does not appear on typical tox screens
Clinical Features
- Uncontrollable laughter
- Intense hallucinations
- Diaphoresis
- Sensations of motion, lights, visions, overlapping realities
- Low toxicity, little hangover, low abuse potential
- Few reports of psychosis and suicide associated with use
Differential Diagnosis
Hallucinations
Serotonin-Like Agents
- Lysergic acid diethylamide (LSD)
- Psilocybin ("magic mushrooms")
- N,N-Dimethyltryptamine (DMT)
- 5-methoxy- dimethyltryptamine (5-MeO-DMT)
- 25C-NBOMe
Enactogens
- Designer amphetamines
- Bath salts
- Ecstasy (MDMA)
- Mescaline (peyote)
- Synthetic cannabinoids
Dissociative Agents
- Phencyclidine (PCP)
- Ketamine
- Dextromethorphan
- Nitrous oxide
Plant-based Hallucinogenics
- Marijuana
- Salvia
- Absinthe
- Isoxazole Mushrooms
- Hawaiian baby woodrose (Argyreia nervosa)
- Hawaiian woodrose (Merremia tuberosa)
- Morning glory (Ipomoea violacea)
- Olili- uqui (Rivea corymbosa)
Organic causes
- Delirium
- Intracranial mass to occipital or temporal lobes
- Encephalitis, limbic encephalitis, anti-NMDA receptor encephalitis
- Migraine
- Seizure
- Hypocalcemia/Hypercalcemia
- Rift valley fever
- Rabies
- Syphilis
- Vitamin B7 deficiency
- Pellagra
- Dementia
Other Toxicologic Causes
- Alcohol withdrawal
- Anticholinergic Toxicity
- Tricyclic (TCA) Toxicity
- Synthetic cannabinoids
- Inhalant abuse
- Nitrogen narcosis
- GHB withdrawal
- Hydrocarbon toxicity
- Heavy metal toxicity
- Multiple medications: montelukast, doxapram, hyoscyamine, tizanidine, peramivir, amantadine, rimantadine, bromocriptine, methylergonovine, benztropine, doxepin, voriconazole, acyclovir, valacyclovir, ganciclovir, cimetidine, penicillin G Procaine, clarithromycin, metoclopramide
- Inhalant abuse
Psychiatric Causes [1]
- Schizophrenia, schizoaffective disorder, schizophreniform disorder
- Depression with psychotic features
- Bipolar disorder
- Charles Bonnet Syndrome (in the visually impaired)
Management
- Supportive
- Benzodiazepines as needed
- Most patients will have symptoms resolve prior to ED arrival given short duration of action
See Also
References
- ↑ Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156