Delirium and High Creatine Kinase and Myoglobin Levels Related to Synthetic Cannabinoid Withdrawal

Table 2

Case 1 clinical observation and treatment.

Day	Psychiatric evaluation	Biochemical parameters						Treatment
		CK^1	CK-MB^2	MB^3	AST^4	SC-1^5	SC-2^6
1	Manic symptoms (euphoria, irritable mood, logorrhoea, delusion)	796	48,4		39	1.5	2,3	Haloperidol 10 mg/d, quetiapine 400 mg/d, risperidone 2 mg/d, diazepam 5 mg/d
2	Manic symptoms							Quetiapine 300 mg/d, risperidone 2 mg/d
3	Manic symptoms							Quetiapine 300 mg/d
4	Delirium symptoms; NDRS:15	2571	66,4		67			5% dextrose 2000 cc/d,; risperidone 2 mg/d, lorazepam 2,5 mg/d
5	Delirium symptoms; NDRS:29	4267	220	708	166	7,22	8,08	Lorazepam 9,5 mg/d, 5% dextrose 1500 cc/d,; 0,9% isotonic 1500 cc/d; Haloperidol 10 mg/d
5	Delirium symptoms; NDRS:30	4267	130	564	140			Lorazepam 2,5 mg/d,; diazepam 30 mg/d; 5% dextrose 1500 cc/d,; 0,9% isotonic 1500 cc/d
7	Delirium symptoms; NDRS:12	2049	56,9	262	96			Diazepam 20 mg/d; 5% dextrose 1500 cc/d,; 0,9% isotonic 1500 cc/d; Haloperidol 10 mg/d
8	Hyperthymia; NDRS: 3	1429	43,7	157	77			Diazepam 20 mg/d; 0,9% isotonic 500 cc/d

Creatine kinase, creatine kinase-MB, myoglobin, aspartate aminotransferase, synthetic cannabinoid-1 (Table 1), and synthetic cannabinoid-2 (Table 1); test results exceed the measurable values.