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Introduction
Since the classification of miaow miaow (mephedrone) as a class B drug in April this year, a new drug is emerging as a so-called 'legal high' under the name ivory wave, purple wave, ivory coast or vanilla sky. It is marketed as bath salts and can be snorted or ingested. Whether or not this drug in fact contains illegal ingredients is as yet unclear. The drug's effects are concerning however, and have been seen in patients in Lothian, Cumbria, Dorset and Essex. The case below occurred in a city where the drug had not been reported before. It is presented here to increase awareness of a drug which seems to be rapidly gaining popularity, with reported cases spreading across the UK.
Case report
A patient presented in a police custody suite complaining of sudden onset of palpitations and chest pain having snorted a drug earlier that day. The patient was extremely agitated and suffering from involuntary facial contortions, hallucinations, profound anxiety and chest pain. The patient appeared hypermetabolic, breathing 28 times per minute, with a pulse between 115 and 160 beats per min and a blood pressure of 160/90 mm Hg. The temperature was recorded at 37.4°C, and the pupils were sluggish at 5 mm. The patient's ECG showed 2 mm S-T depression in the anterior...