All bath salts are not mephedrone

February 4, 2012, 12:56 am

★★½☆☆

“Bath Salt” Ingestion Leading to Severe Intoxication Delirium: Two Cases and a Brief Review of the Emergence of Mephedrone Use. Kasick DP et al. Am J Drug Alcohol Abuse 2012 Jan 5 [Epub ahead of print]

Abstract 

This paper from the Ohio State Department of Psychiatry is worth reading for vivid descriptions of acute toxic delirium in two patients after they used a product sold as “bath salts”:

  • Patient A presented after ingesting “bath salts” sold under the label “Arctic Blast”. He was tachycardic (heart rate = 144.min), anxious and paranoid, and suffering visual hallucinations of snakes. For some bizarre reason he was given 2 mg naloxone in the field. At the hospital, he slowly improved after treatment with fluids, lorazepam, and haloperidol.
  • Patient B snorted four lines of “Posh Aromatherapy Bath Salts”, and presented with paranoia, delirium tremors, hyperreflexia, clonus, as well as visual and auditory hallucinations that lasted for 2 days. He also gradually recovered normal mental status after treatment with fluids, lorazepam, and risperidone.

The authors’ discussion of mephedrone is somewhat strange, since bath salts can contain other drugs and no definitive testing was carried in in either of these cases. ¬†According to the U.S. Department of Justice National Drug Intelligence Center, baths salts can contain any of a number of synthetic cathinones:

  • MDPV
  • Mephedrone
  • Methylone
  • Naphrone
  • 4-Fluoromethcatinone (flephedrone)
  • 3-Fluoromethcathinone
  • Methedrone
  • Butylone

Fortunately, treatment of toxicity from synthetic cathinones does not depend on the exact substance involved. This includes: fluids, sedation, detecting and reversing significant hyperthermia, and monitoring for rhabdomyolysis and acute renal failure.

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