Case series: compartment syndrome associated with exposure to “bath salts”

March 4, 2013, 10:14 pm


Compartment Syndrome After “Bath Salts” Use: A Case Series. Levine M et al. Ann Emerg Med 2013 Jan 11 [Epub ahead of print]


Although use of the designer drugs called “bath salts” — usually containing the sympathomimetic stimulants MPDV and/or mephedrone — has only been prevalent for the last several years, the common serious adverse effects are well known: hyperthermia, agitated delirium, rhabdomyolysis, and hyponatremia.There have to my knowledge been no cases previously reported of compartment syndrome associated with bath salt use.

This case series describes 3 patients who developed compartment syndrome after injecting or snorting bath salts. All patients were agitated and had signs and symptoms consisted with sympathomimetic syndrome. Patient #1 complained of significant forearm pain. Evaluation revealed high compartment pressures that were treated by fasciotomy. Patient #2 exhibited firmness and tenderness of the paraspinal muscles. At surgery , the deep lumbar paraspinous compartments were tight with necrotic muscle tissue. Patient #3 complained of thoracolumbar back pain, Pressures in the paraspinal compartments were elevated, and MRI showed edematous muscles. Treatment was non-surgical.

All patients test positive for synthetic stimulants (MDPV or α-Pyrrolidinopentiophenone). One patient (#2) was still dependent on hemodialysis 5months after exposure.

The main take-home lesson for emergency clinicians is that any patient who comes in with significant toxicity from “bath salts” should be questions about muscle pain, and examined for firm and/or tender muscle compartments. Any reported pain — especially back pain — should be taken seriously.

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Vivid Navy video depicts horrors of bath salts

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Agitation and hallucinations from bath salts containing MDPV and flephedrone

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Death from MDPV-associated excited delirium

Bath salts and necrotizing fasciitis: a case report

All bath salts are not mephedrone 

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Toxicology of Synthetic Cathinones

The science of designer drugs: essential review

Baths salts: calls to poison centers in Louisiana and Kentucky

New York Times on bath salts

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

“Bath salts” in Michigan

Dr. Oz on bath salts (MDPV)

NBC’s Today show reports on “bath salts” (MDPV)





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