Bath Salts – Synthetic Cathinones Poisoning

Bath Salts – Synthetic Cathinones Poisoning is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

“Bath salts”:
  • General term for “designer drugs” containing synthetic cathinones:
    • 3,4 methylenedioxypyrovalerone (MDPV) is most common in US
      • Also mephedrone, methylone, and many others
  • Sold under numerous names including
    • Aura, Bliss, Bolivian Bath, Cloud 9, Ivory Snow, Ivory Wave, Vanilla Sky, White Dove, White Rush
      • Labeled “not for human consumption” to evade regulatory control
      • Falsely marketed as plant food, insect repellents, “bath salts”
  • Substances may be powders, tablets, or crystals:
    • Ranging in color from white, yellow, brown, or gray
  • May be ingested, snorted, smoked, injected
  • Highly addictive CNS stimulant, often with hallucinogenic properties:
    • Many effects similar to cocaine, methamphetamine, or ecstasy
    • Severe delirium, psychosis, violence, multiorgan failure, DIC, myocardial infarction, stroke, and deaths have been reported

Epidemiology

Incidence and Prevalence Estimates
  • 1st use in US reported in 2010
    • MDPV and mephedrone noted in Europe since 2004
  • Called “America's new drug problem” in 2011
    • Thousands of cases reported to poison control centers nationwide
  • Immediate temporary classification (Fall 2011) as a DEA schedule I controlled substance
  • Still available at retail shops or through the internet

Etiology

  • MDPV is structurally similar to cathinone, an alkaloid derived from the khat plant (chewed socially and abused for centuries in East Africa and Arabian Peninsula)
  • Drug chemical formulas change regularly to evade detection, compound identification, and classification as “illegal”
  • Principal toxicity derives from effects on dopamine, norepinephrine, and serotonin receptors
  • Effects from potential adulterants and contaminants in the drugs remain unknown

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