Bath salts

From WikEM
Revision as of 23:06, 6 May 2017 by Lisayee25 (Talk | contribs) (Management)

Jump to: navigation, search

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

Evaluation

  • 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

Management

  • Benzodiazepines for agitation
  • Do not use butyrophenones (Haldol) or second gen antipsychotic (Geodon) first line
    • Interfere with heat dissipation, lower seizure threshold, may prolong QTc
  • Rapid cooling for hyperthermia
  • Paralyze if hyperthermia uncontrolled (avoid Succinylcholine due to hyperkalemia)
  • IV hydration
  • Monitor urine output

Disposition

  • Discharge if AMS and sympathomimetic symptoms resolve with out end-organ damage
  • Admit for lab abnormalities or persistent AMS

See Also

References