Bath salts toxicity: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
===Work-Up=== | |||
==Work-Up== | |||
*Fingerstick glucose | *Fingerstick glucose | ||
*Complete metabolic panel | *Complete metabolic panel | ||
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*Total CK | *Total CK | ||
*Utox not helpful, usually negative | *Utox not helpful, usually negative | ||
==Diagnosis== | |||
*Diagnosis based on history and physical exam | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==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== | |||
*Discharge if [[Altered Mental Status (AMS)|AMS]] and [[Sympathomimetic toxicity|sympathomimetic]] symptoms resolve with out end-organ damage | |||
*Admit for lab abnormalities or persistent [[Altered Mental Status (AMS)|AMS]] | |||
==Complications== | ==Complications== | ||
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*[[Aortic dissection]] | *[[Aortic dissection]] | ||
*Acute tubular necrosis | *Acute tubular necrosis | ||
==See Also== | ==See Also== | ||
Revision as of 04:50, 22 May 2017
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 toxicity + Psychomotor agitation + Hallucinations
- Sympathomimetic toxidrome
- Tachycardia
- Hypertension
- Agitation
- Paranoia
- Hyperthermia
- Hallucinogenic
Evaluation
Work-Up
- Fingerstick glucose
- Complete metabolic panel
- LFTs
- Coags
- Total CK
- Utox not helpful, usually negative
Diagnosis
- Diagnosis based on history and physical exam
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
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