Bath salts toxicity

Background

• Found in herbal products sold over the internet or convenient stores under guise of bath salts "not for human consumption"
  • May be found under brand name Aura, Ivory wave, Vanilla sky
• Active ingredients vary widely
  • Methylenedioxyprovalerone (MDPV)
  • Methadrone
• Similar effects to MDMA, cocaine, methamphetamines

Clinical features

• 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

DDX

• See Altered Mental Status (AMS)

Treatment

• Benzodiazepines or Haldoperidol for agitation
• Rapid cooling for hyperthermia
  • cooling blankets
  • cooling fans
  • Ice packs
• IV hydration
• Monitor urine output

Disposition

• Patients whose altered mental status and sympathomimetic symptoms resolve and do not demonstrate evidence of end organ damage may be discharged
• Admit patients with laboratory abnormalities or persistent altered mental status

Sources

• Uptodate
• EMRAP