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 MDMA, cocaine, methamphetamines

Clinical features

Sympathomimetic intoxication + 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 e/o end-organ damage
• Admit for lab abnormalities or persistent AMS

Sources

• UpToDate
• EMRAP