Bath salts toxicity
Background
Bath salts
- Found in herbal products sold under guise of "not for human consumption"
- May be found under brand name Aura, Ivory wave, Vanilla sky
- Active ingredients vary; often contain methylenedioxyprovalerone (MDPV) or mephedrone
- Similar effects to Ecstasy (MDMA), cocaine, methamphetamines
Clinical features
- Sympathomimetic toxidrome
- Tachycardia
- Hypertension
- Agitation
- Paranoia
- Hyperthermia
- Hallucinations
- Psychomotor agitation
Differential Diagnosis
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
Evaluation
Work-Up
- Fingerstick glucose
- Complete metabolic panel
- Coags
- CK
- Urine tox screen not helpful, usually negative
Diagnosis
- Diagnosis is based on history and physical exam
Management
- Benzodiazepines for agitation
- Rapid cooling for hyperthermia
- Paralyze if hyperthermia uncontrolled (avoid Succinylcholine due to hyperkalemia)
- IV hydration
- Monitor urine output
Contra-indicated
- Do not use butyrophenones (e.g. Haldol) or second gen antipsychotic (e.g. Geodon) as first line agents
- They interfere with heat dissipation, lower seizure threshold, may prolong QTc
Disposition
- Discharge if AMS and sympathomimetic symptoms resolve with out end-organ damage
- Admit for lab abnormalities or persistent AMS
Complications
- Rhabdomyolysis
- Cardiomyopathy
- Valvular heart disease
- Cardiac arrhythmias
- Pulmonary hypertension
- Aortic dissection
- Acute tubular necrosis
References
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