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“Bath salts” intoxication: a new recreational drug that presents with a familiar toxidrome

Published online by Cambridge University Press:  04 March 2015

Christine Hall*
Affiliation:
Vancouver Island Health Authority, Victoria, BC; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; and the Faculty of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, AB
Christopher Heyd
Affiliation:
Island Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, BC
Chris Butler
Affiliation:
Calgary Police Service, Calgary, AB
Mark Yarema
Affiliation:
Poison and Drug Information Service, Alberta Health Services; the Division of Emergency Medicine, University of Calgary, Calgary, AB
*
Department of Emergency Medicine, University of British Columbia, Royal Jubilee Hospital, 1952 Bay Street, Victoria, BC V8R 1J8;Christine.Hall@viha.ca

Abstract

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It is important for emergency physicians to be aware of new psychoactive agents being used as recreational drugs. “Bath salts,” which include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, are the newest recreational stimulants to appear in Canada. There are currently more than 12 synthetic cathinones marketed as bath salts and used with increasing frequency recreationally. Although these drugs are now illegal in Canada, they are widely available online. We present a case report and discuss bath salts intoxication and its anticipated sympathomimetic toxidrome, treatment strategies, and toxicologic analysis, Treatment should not rely on laboratory confirmation. Since the laboratory identification of such drugs varies by institution and toxicologic assay, physicians should not misconstrue a negative toxicology screen as evidence of no exposure to synthetic cathinones. Illicit bath salts represent an increasing public health concern that involves risk to the user, prehospital personnel, and health care providers.

Type
Case Report • Rapport De Cas
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Coppola, M, Mondola, R. 3,4-Methylenedioxypyrovalerone (MDPV): chemistry, pharmacology and toxicology of a new designer drug of abuse marketed online. Toxicol Lett 2012;208:12–5, doi:10.1016/j.toxlet.2011.10.002.CrossRefGoogle ScholarPubMed
2. Emergency department visits after use of a drug sold as “bath salts”—Michigan, November 13, 2010-March 31, 2011. MMWR Morb Mortal Wkly Rep 2011;60:624–7.Google Scholar
3. Murray, BL, Murphy, CM, Beuhler, MC. Death following recreational use of designer drug “bath salts” containing 3,4- methylenedioxypyrovalerone (MDPV). J Med Toxicol 2012;8:6975, doi:10.1007/s13181-011-0196-9.CrossRefGoogle Scholar
4. Spiller, HA, Ryan, ML, Weston, RG, Jansen, J. Clinical experience with and analytical confirmation of “bath salts” and “legal highs” (synthetic cathinones) in the United States. Clin Toxicol (Phila) 2011;49:499505, doi:10.3109/15563650.2011.590812.CrossRefGoogle ScholarPubMed
5. Black, M. What are “bath salts”? A look at Canada’s newest illegal drug. CBC News. 2012. Available at: (accessed July 15, 2013).Google Scholar
6. Health Canada. Schedule I Controlled Drugs and Substances Act. 2012. Available at: (accessed November 12,2012).Google Scholar
7. Prosser , JM, Nelson, LS. The toxicology of bath salts: a review of synthetic cathinones. J Med Toxicol 2012;8:3342, doi:10.1007/s13181-011-0193-z.CrossRefGoogle ScholarPubMed
8. Ross, EA, Reisfield, GM, Watson, MC, et al. Psychoactive “bath salts” intoxication with methylenedioxypyrovalerone. Am J Med 2012;125:854–8, doi:10.1016/j.amjmed.2012.02.019. [Epub 2012 Jun 9]CrossRefGoogle ScholarPubMed
9. Kelly, JP. Cathinone derivatives: a review of their chemistry, pharmacology and toxicology. Drug Test Anal 2011;3:439–53, doi:10.1002/dta.313.CrossRefGoogle ScholarPubMed
10. Borek, HA, Holstege, CP. Hyperthermia and multiorgan failure after abuse of “bath salts” containing 3,4-methylenedioxypyrovalerone. Ann Emerg Med 2012;60:103–5, doi:10.1016/j.annemergmed.2012.01.005.CrossRefGoogle ScholarPubMed
11. Kasick, DP, McKnight, CA, Klisovic, E. “Bath salt” ingestion leading to severe intoxication delirium: two cases and a brief review of the emergence of mephedrone use. Am J Drug Alcohol Abuse 2012;38:176–80, doi:10.3109/00952990.2011.643999.CrossRefGoogle Scholar
12. Mugele, J, Nanagas, KA, Tormoehlen, LM. Serotonin syndrome associated with MDPV use: a case report. Ann Emerg Med 2012;60:100–2, doi:10.1016/j.annemergmed.2011.11.033.CrossRefGoogle ScholarPubMed
13. Kriikku, P, Wilhelm, L, Schwarz, O, Rintatalo, J. New designer drug of abuse: 3,4-methylenedioxypyrovalerone (MDPV). Findings from apprehended drivers in Finland. Forensic Sci Int 2011;210:195200, doi:10.1016/j.forsciint.2011.03.015.CrossRefGoogle ScholarPubMed
14. Penders, TM, Gestring, RE, Vilensky, DA. Intoxication delirium following use of synthetic cathinone derivatives. Am J Drug Alcohol Abuse 2012;38:616–7, doi:10.3109/00952990.2012.694535. [Epub 2012 Jul 11]CrossRefGoogle ScholarPubMed
15. Penders, TM. How to recognize a patient who’s high on “bath salts.” J Fam Pract 2012;61:210–2.Google ScholarPubMed
16. Penders, TM, Gestring, R. Hallucinatory delirium following use of MDPV: “bath salts.” Gen Hosp Psychiatry 2011;33:525–6, doi:10.1016/j.genhosppsych.2011.05.014.CrossRefGoogle ScholarPubMed
17. Antonowicz, JL, Metzger, AK, Ramanujam, SL. Paranoid psychosis induced by consumption of methylenedioxypyrovalerone: two cases. Gen Hosp Psychiatry 2011;33:640–6.Google ScholarPubMed
18. Vilke, GM, Bozeman, WP, Dawes, DM, et al. Excited delirium syndrome (ExDS): treatment options and considerations. J Forensic Leg Med 2012;19:117–21, doi:10.1016/j.jflm.2011.12.009.CrossRefGoogle Scholar
19. Vilke, GM, Payne-James, J, Karch, SB. Excited delirium syndrome (ExDS): redefining an old diagnosis. J Forensic Leg Med 2012;19:711, doi:10.1016/j.jflm.2011.10.006.CrossRefGoogle ScholarPubMed
21. Vilke, GM, Debard, ML, Chan, TC, et al. Excited delirium syndrome (ExDS): defining based on a review of the literature. J Emerg Med 2012;43:897905, doi:10.1016/j.jemermed.2011.02.017. [Epub 2011 Mar 25]CrossRefGoogle ScholarPubMed
22. Ramoska, E, Sacchetti, AD. Propranolol-induced hypertension in treatment of cocaine intoxication. Ann Emerg Med 1985;14:1112–3, doi:10.1016/S0196-0644(85)80934-3.CrossRefGoogle ScholarPubMed