The Poison Review

Clinical experience with and analytical confirmation of “bath salts” and “legal highs” (synthetic cathinones) in the United States. Spiller HA et al. Clin Toxicol 2011 Jul;49:499-505.

Abstract

The title of this article grossly overstates what it contains.  It is a retrospective review of “bath salt” exposure not in the “United States”, but rather as reported to two state-wide poison control centers (Kentucky and Louisiana). It does not really describe direct “clinical experience”, but instead data reported to and recorded by the regional poison control centers. (The calls came both from medical professionals and the lay public.) And “analytical confirmation” occurred in just a small minority of patients. Nevertheless, the paper is well worth reading, especially since there’s still not much medical literature related to the “bath salt” phenomenon. The authors retrospectively reviewed records from a computerized database to identify calls related to “bath salts” received by the two poison control centers over a period of approximately 1 year (January 2010 through February 2011). It is not clear to me what methods were used to confirm that each case actually represented bath salt or synthetic cathinone exposure. They found 236 cases, 22% of which represented calls from the general public. Clinical effects were predominantly cardiovascular and neurological, consistent with the sympathomimetic toxidrome, with a high incidence of aggressive violent behavior, hallucinations, and paranoia. The paper also describes cases of alarmingly dangerous behavior:

Examples of these new onset behaviors in separate patients included: jumping out of a window to flee from non-existent pursuers; requiring electrical shock (Taser) and eight responders to initially subdue the patient; repeatedly firing guns out of the house windows at “strangers” who were not there; walking into a river in January to look for a friend who was not there; leaving a 2-year-old daughter in the middle of a highway because she had demons; climbing into the attic of the home with a gun to kill demons that were hiding there, and breaking all the windows in a house and wantering barefoot through the broken glass.

There was one death: a 21-year-old man shot himself during a delusional episode. This seems to be the well-known tragic case of Dickie Sanders described in the following piece from NBC’s Today show:

Blood and/or urine tests for synthetic cathinones were carried out on samples from 19 patients; the only psychoactive stimulant detected was MDPV. In addition, 15 “bath salt” products were obtained and tested, all of which contained MDPV, mephedrone, and/or methylone.

It’s always important to keep in mind that “bath salts” and “legal highs” are moving targets, as suppliers attempt to stay one step ahead of the law and specific substances are increasingly being banned by state legislatures.  However, management of patients presenting with a sympathomimetic toxidrome does not depend on what specific stimulant they’ve been exposed to, and is based on principles outlined in a recent letter in the New England Journal of Medicine.

Click here to reveal the 39 different product names reported by users

Related posts:

New England Journal of Medicine on “Bath Salts”

New York Times on Bath Salts

NBC’s Dateline goes undercover to investigate the “bath salt” industry

“Bath salts” in Michigan

Were “bath salts” involved in a double murder/suicide in Washington State?

Dr. Oz on bath salts (MDPV)

NBC’s Today Show reports on bath salts (MDPV)

Death in Britain: “Ivory Wave” (MDPV) or diabetic ketoacidosis

“Ivory Wave” identified as MDPV

It’s not your mom’s bath salts

To read my Emergency Medicine News column on bath salts, click here.