Pneumotox » Drug » Cannabinoids - Cannabinoid receptor agonists (synthetic) (K2, Spice)

Cannabinoids - Cannabinoid receptor agonists (synthetic) (K2, Spice)

a.k.a. Spice, K2 bonsai or other colourful names. Include MDMB-CHMICA. Review: PMID 27610597. See also under PMID 27973993. Such adulterants as warfarin or superwarfarins should be examined (PMID 30104022)

Last update : 25/08/2023

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.e Acute eosinophilic pneumonia (AEP)

II.a Pulmonary edema, noncardiogenic (NCPE)

II.b ARDS - Acute lung injury

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

III.c Hemoptysis

III.m Coagulopathy

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

VII.h Pneumomediastinum

VIII.b Hematoma of/around central airway wall potentially causing UAO

IX.d Respiratory failure from ventilatory depression (due to neuromuscular blockade/paralysis)

X.u Multiple organ dysfunction/failure (MODS/MOF)

X.ba Rhabdomyolysis (see also under Xj)

XI.b Chest pain (acute or subacute), lone or prominent

XI.r Death following exposure or poisoning

XI.aa CNS symptoms or involvement, stroke

XII.g Coronary artery disease (acute) - Myocardial ischemia/infarction

XII.l Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)

XII.aj Systemic arterial thrombosis

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France