Bath salts toxicity: Difference between revisions
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==Background== | ==Background== | ||
[[File:RadoxBathSalts.jpg|thumb|Bath salts]] | |||
*Found in herbal products sold under guise of "not for human consumption" | *Found in herbal products sold under guise of "not for human consumption" | ||
**May be found under brand name Aura, Ivory wave, Vanilla sky | **May be found under brand name Aura, Ivory wave, Vanilla sky | ||
| Line 5: | Line 6: | ||
*Similar effects to [[Ecstasy (MDMA)]], [[cocaine]], [[methamphetamines]] | *Similar effects to [[Ecstasy (MDMA)]], [[cocaine]], [[methamphetamines]] | ||
==Clinical | ==Clinical Features== | ||
*[[Sympathomimetic toxicity|Sympathomimetic toxidrome]] | *[[Sympathomimetic toxicity|Sympathomimetic toxidrome]] | ||
**Tachycardia | **Tachycardia | ||
| Line 14: | Line 13: | ||
**Paranoia | **Paranoia | ||
**Hyperthermia | **Hyperthermia | ||
* | *[[Hallucinations]] | ||
*Psychomotor agitation | |||
==Differential Diagnosis== | |||
{{Sympathomimetic types}} | |||
{{Drugs of abuse types}} | |||
==Evaluation== | ==Evaluation== | ||
===Work-Up=== | |||
==Work-Up== | |||
*Fingerstick glucose | *Fingerstick glucose | ||
*Complete metabolic panel | *Complete metabolic panel | ||
*Coags | *Coags | ||
* | *CK | ||
* | *Urine tox screen not helpful, usually negative | ||
== | ===Diagnosis=== | ||
*Diagnosis is based on history and physical exam | |||
==Management== | ==Management== | ||
*[[Benzodiazepines]] for agitation | *[[Benzodiazepines]] for agitation | ||
*Rapid cooling for hyperthermia | *Rapid cooling for hyperthermia | ||
*Paralyze if hyperthermia uncontrolled (avoid [[Succinylcholine]] due to hyperkalemia) | *Paralyze if hyperthermia uncontrolled (avoid [[Succinylcholine]] due to hyperkalemia) | ||
*IV hydration | *IV hydration | ||
*Monitor urine output | *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== | |||
===Admission=== | |||
*Admit for lab abnormalities or persistent [[Altered Mental Status (AMS)|AMS]] | |||
===Discharge=== | |||
*Discharge after observation period if [[Altered Mental Status (AMS)|AMS]] and [[Sympathomimetic toxicity|sympathomimetic]] symptoms resolve with out end-organ damage | |||
*MDPV has an estimated 6-8 hour duration of action, but may vary. Consider consult with poison control prior to discharge. | |||
==Complications== | ==Complications== | ||
| Line 47: | Line 57: | ||
*[[Aortic dissection]] | *[[Aortic dissection]] | ||
*Acute tubular necrosis | *Acute tubular necrosis | ||
==See Also== | ==See Also== | ||
*[[Sympathomimetic toxicity]] | *[[Sympathomimetic toxicity]] | ||
*[[Altered Mental Status (AMS)]] | *[[Altered Mental Status (AMS)]] | ||
==External Links== | |||
*[http://www.emdocs.net/bath-salts/ emDocs - Bath Salts] | |||
==References== | ==References== | ||
Latest revision as of 23:29, 21 April 2022
Background
- 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
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Difluoroethane
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
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
Admission
- Admit for lab abnormalities or persistent AMS
Discharge
- Discharge after observation period if AMS and sympathomimetic symptoms resolve with out end-organ damage
- MDPV has an estimated 6-8 hour duration of action, but may vary. Consider consult with poison control prior to discharge.
Complications
- Rhabdomyolysis
- Cardiomyopathy
- Valvular heart disease
- Cardiac arrhythmias
- Pulmonary hypertension
- Aortic dissection
- Acute tubular necrosis