Bath salts toxicity: Difference between revisions
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==Background == | ==Background== | ||
*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 | ||
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*Similar effects to [[Ecstasy (MDMA)]], [[cocaine]], [[methamphetamines]] | *Similar effects to [[Ecstasy (MDMA)]], [[cocaine]], [[methamphetamines]] | ||
==Clinical features == | ==Clinical features== | ||
[[Sympathomimetic toxicity]] + Psychomotor agitation + [[Hallucinations]] | [[Sympathomimetic toxicity]] + Psychomotor agitation + [[Hallucinations]] | ||
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*Hallucinogenic | *Hallucinogenic | ||
==Diagnosis == | ==Diagnosis== | ||
*Diagnosis based on history and physical exam | *Diagnosis based on history and physical exam | ||
==Work-Up == | ==Work-Up== | ||
*Fingerstick glucose | *Fingerstick glucose | ||
*Complete metabolic panel | *Complete metabolic panel | ||
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*Utox not helpful, usually negative | *Utox not helpful, usually negative | ||
==Differential Diagnosis == | ==Differential Diagnosis== | ||
{{Sympathomimetic types}} | {{Sympathomimetic types}} | ||
==Treatment == | ==Treatment== | ||
*[[Benzodiazepines]] or haldol for agitation | *[[Benzodiazepines]] or haldol for agitation | ||
*Rapid cooling for hyperthermia | *Rapid cooling for hyperthermia | ||
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*Monitor urine output | *Monitor urine output | ||
==Disposition == | ==Disposition== | ||
*Discharge if [[Altered Mental Status (AMS)|AMS]] and [[Sympathomimetic toxicity|sympathomimetic]] symptoms resolve w/o end-organ damage | *Discharge if [[Altered Mental Status (AMS)|AMS]] and [[Sympathomimetic toxicity|sympathomimetic]] symptoms resolve w/o end-organ damage | ||
*Admit for lab abnormalities or persistent [[Altered Mental Status (AMS)|AMS]] | *Admit for lab abnormalities or persistent [[Altered Mental Status (AMS)|AMS]] | ||
Revision as of 21:17, 7 July 2016
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
Diagnosis
- Diagnosis based on history and physical exam
Work-Up
- Fingerstick glucose
- Complete metabolic panel
- LFTs
- Coags
- Total CK
- Utox not helpful, usually negative
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Treatment
- Benzodiazepines or haldol for agitation
- Rapid cooling for hyperthermia
- IV hydration
- Monitor urine output
Disposition
- Discharge if AMS and sympathomimetic symptoms resolve w/o end-organ damage
- Admit for lab abnormalities or persistent AMS