The patient is a 27-year-old stock exchange worker who presents to the ED with a complaint of anxiety, chest pain, sweating, palpitations and a feeling of paranoia and impending doom following the recreational ingestion of bath salts two hours prior at a company party.His pulse is: 120 beat/min; blood pressure: 170/100; respiratory rate: 32 breaths/min and temperature 100.7 F. He is pacing around the triage area demanding to see the doctor in charge.
Bath Salt Abuse
Bath salts are designer or synthetic drugs often containing amphetamine-like substances such as mephedrone, methylenedioxypyrovalerone (MDPV) which are similar to the amphetamine-like substance metcathinoine found in Cat or Qat. Concentrated bath salt products are widely available on the internet and can be found in stores, truck stops and gas stations under names like Zoom 2, Aura, Vanilla Sky, Ivory Wave and White Rush. (Table 1) Mephedrone is a central nervous system stimulant, causing a sympathomimetic reaction with occasional psychological symptoms such as delusions, paranoia, psychosis and hallucinations. Addictive properties have been described with chronic use. The number of calls reported to national Poison Control Centers and visits to emergency departments have risen exponentially over the past several months. The most profound side effects from large overdoses include seizures, rhabdomyolysis, renal failure, and rarely death.
Like amphetamines and cocaine, the drug can be snorted, smoked, injected but can also be mixed into alcoholic beverages. Recreationally, the drugs use was intended to be a legal synthetic high, much like the synthetic cannabinoid K-2 or Spice. The street value of a half gram package generally costs $25 to $30. Currently banned in the UK and several US States, there are plans to introduce a bill in Congress to impose a nationwide ban.
The drug can also cause combative behavior. In Panama City, Florida, two incidents alerted authorities to the drugs serious effects. In one case, several officers were needed to subdue a man who tore a radar unit out of a police car with his teeth. In another incident, police say a woman attacked her mother with a machete, thinking she was a monster. Still another user vowed to extract his own liver with a mechanical pencil. Never a dull moment in the world of designer drugs