Bath salts toxicity

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

Differential Diagnosis

Sympathomimetics

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

See Also

References

Authors:

Ross Donaldson