Morning Report: 8/2/2012

Thanks to Dr. Melendez for today’s Morning Report!

Bath Salts

Multiple drugs which are difficult to detect on drug screens have been made and used in an attempt to circumvent detection. The use of bath salts in the US has increased considerably over the last 2 years.

In 2010 there were 303 calls to poison centers regarding bath salt toxicity and by June 2011 there were nearly 4000.

Due to their effects, they were federally banned in the US in September 2011.

There are multiple versions of bath salts. The most common uses the active ingredients Mephedrone and Methylenedioxypyrovalerone (MDPV). The “street names” for mephedrone bath salts are numerous and include ivory snow, vanilla sky, arctic blast, white rush, and white knight.

Marketed as “bath salts” and labeled as “not for human consumption”, they are often sold at tattoo parlors, night clubs, truck stops and on in the internet. They are primarily snorted but they can also be ingested, smoked or administered IV and they are frequently mixed with cocaine.

Mechanism of action: NE and Dopamine reuptake inhibitors.

Effects:

As with other drugs, it is taken to achieve a state of euphoria. It can cause increased alertness, as well as increased energy and motivation.

Onset is between 5 minutes to 1 hour depending in route of administration. Duration is 2 to 7 hours.

Undesirable effects: Aggression, agitation, violent behavior, delusions, hallucinations, paranoia, suicidal or homicidal behaviors. Also have sympathomimetic properties resulting in hypertension, tachycardia, hyperthermia and seizures. They are also known to cause rhabdomyolysis, renal failure and respiratory difficulty.

Treatment of Acute Toxicity

General supportive care (IVF, benzos) is the main treatment measure for sympathomimetic toxicity because no antidote exists. Assessment of the airway, breathing, and circulation immediately is recommended. In addition, close monitoring of the vital signs is recommended.

It is imperative to measure the core temperature of sympathomimetic poisoned patients. If hyperthermia is present, standard cooling measures should be initiated. Controlling agitation significantly helps in cooling a hyperthermic patient.

Getting labs? As always, check for co-ingestions. Pay attention to electrolytes, Cr and CK (rhabdomyolysis); Cardiac markers (eg, CPK-MB, troponin) are also appropriate to screen for cardiac injury

Imaging? Consider a CT scan of the head to rule out intracerebral bleeds in unresponsive patients or those with focal neurologic deficits. Obtain an electrocardiogram (ECG) to check for evidence of myocardial ischemia and dysrhythmias.

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