We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Difference between revisions of "Bath salts"
From WikEM
(→Management) |
|||
Line 31: | Line 31: | ||
==Management== | ==Management== | ||
− | *[[Benzodiazepines]] | + | *[[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 | *Rapid cooling for hyperthermia | ||
*Paralyze if hyperthermia uncontrolled (avoid [[Succinylcholine]] due to hyperkalemia) | *Paralyze if hyperthermia uncontrolled (avoid [[Succinylcholine]] due to hyperkalemia) |
Revision as of 23:06, 6 May 2017
Contents
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
- Sympathomimetic toxidrome
- Tachycardia
- Hypertension
- Agitation
- Paranoia
- Hyperthermia
- Hallucinogenic
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