“Bath Salt” Ingestion Leading to Severe Intoxication Delirium: Two Cases and a Brief Review of the Emergence of Mephedrone Use

Department of Psychiatry, The Ohio State University College of Medicine, Columbus, 43210, USA.
The American Journal of Drug and Alcohol Abuse (Impact Factor: 1.78). 03/2012; 38(2):176-80. DOI: 10.3109/00952990.2011.643999
Source: PubMed


Recreational use of designer substances containing synthetic cathinones such as mephedrone, commonly sold as "bath salts," has recently been increasing in the United States (National Institute on Drug Abuse. Available at: Accessed March 25, 2011; The Washington Post. Available at: Accessed March 25, 2011). "Bath salt" ingestion can generate an intense stimulant toxidrome and has been associated with significant morbidity.
The authors seek to alert clinicians to the potential for profound delirium, psychosis, and other medical and behavioral sequelae of "bath salt" use.
Case series.
We describe our recent experience with two highly agitated and delirious patients following "bath salt" ingestion and offer a brief review of the emergence of this phenomenon.
Challenges and strategies surrounding diagnosis and treatment are described, which may be useful as "bath salt" use becomes more widespread.
As an emerging trend, bath salt intoxication delirium appears to cause intense psychosis that can be managed with antipsychotic medications. Clinicians should be aware of this phenomenon until more precise detection methods are available.

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    • "De hecho, las recientes incautaciones de éxtasis efectuadas por la policía europea indican que las tabletas a menudo contienen una mezcla de mefedrona, MDMA y cafeína, con la mefedrona como componente principal en la mayoría de los análisis (Brunt et al., 2011). Las sales de baño son polvos de catinona sintética distribuidos bajo nombres comerciales tales como " Ivory Wave " , " White Lightning " o " Vanilla Sky " y etiquetados como " no apto para el consumo humano " para evitar la legislación vigente sobre drogas ilegales (Davies et al., 2010; Kasick et al., 2012; Winstock et al., 2011). Estos compuestos se suelen inhalar, pero la congestión nasal lleva a muchos usuarios a fumarlas, ingerirlas, usar la vía rectal, o inyectarlas por vía intravenosa o intramuscular (Kavanagh et al., 2013). "
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    ABSTRACT: Synthetic cathinones are a new class of designer drug of the hallucinogenic stimulant type with effects similar to cocaine, methylenedioxymethamphetamine (MDMA) and other amphetamines. The abuse of synthetic cathinones often included in products sold as “bath salts” became fashionable in early 2009, which led to legislative classification across Europe in 2010 and Schedule I drug classification in the USA in 2011. Recent clinical studies indicate that the action mechanism of synthetic cathinone affects the central monoamine systems. In this paper we will review the history of these drugs, their action mechanism, toxicology and legal aspects.
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    • "Current availability of information on the short-and long-term human toxicological implications of synthetic cathinone use remains limited. Reported indicators of acute toxicity include psychomotor agitation, motor automatisms , tachycardia, Parkinsonism, tremors; hypertension, chest pain, hyperthermia, mydriasis, delusions, paranoid psychosis, dizziness, depression, rhabdomyolysis, convulsion , panic attacks, abdominal pain, hyponatremia, vomiting , cerebral edema, and seizures, with chronic effects including changes in cognition and emotional stability, S–T segment changes, nephrotoxicity, and monoamine dysfunction (Bajaj, Mullen & Wylie 2010; Mackay, Taylor & Bajaj 2011; Urban et al. 2011; Omer & Doherty 2011; James et al. 2011; Kasick et al. 2012; Spiller et al. 2011; Regan et al. 2011; Van Hout & Bingham 2012). Severe cases of acute toxicity and fatalities have been reported (Maskell et al. 2001; Gustavsson & Escher 2009; Torrance & Cooper 2010; Wood et al. 2010a; 2010b; Lusthof et al. 2011; Wong & Holt 2011; Wood et al. 2011), but in many cases the presence of multiple drugs of abuse contributed to greater monoamine toxicity (Maskell et al. 2011; Coppola & Mondola 2012; Aromatario et al. 2012; Schifano et al. 2012; Prosser & Nelson 2012). "
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    ABSTRACT: Abstract A synthetic cathinone called 4-methylethcathinone (4-MEC) emerged online in 2010, and was cyber-marketed to be a replacement for mephedrone. The study aimed to present user experiences of 4-MEC as reported on the Internet, with a focus on user profiles, sourcing and product characteristics, routes of administration, dosage, positive and undesirable effects, and comparisons to mephedrone. Twenty-three individual, anonymous trip reports of the sole use of 4-MEC, and 112 screenshots of general 4-MEC user discussion boards, were taken from a purposeful sample of public drug-related sites. A content textual analysis was conducted on extracted qualitative information and produced 41 categories compiled into five general themes: "Type of 4-MEC user"; "Sourcing, informed decision making, product characteristics, and quality assurance"; "Routes of administration, gauging of dosage, and consumption of other drugs"; "Time course effects and outcomes"; and "Comparisons with mephedrone." 4-MEC is sold as white beads, crystalline shards, or green balls. User motives centered on curiosity, pricing, and ease of web sourcing. Oral, nasal, injecting, eyeball, and rectal routes of administration were described. Testing for purity, "allergy testing," and gauging of dosage were common. Users described euphoric but short-lived effects, with little comedown. Continued research is vital to inform harm reduction.
    Journal of psychoactive drugs 09/2014; 46(4):273-286. DOI:10.1080/02791072.2014.934979 · 1.10 Impact Factor
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    • "Some cathinones, including MDPV, produced false-positive results in phencyclidine (PCP) immunoassays. [9] [53] [54] Additionally, Swortwood et al. reported positive Immunalysis and Neogen methamphetamine tests with synthetic cathinone concentrations starting at 1250 μg/L. [55] Greater cross-reactivity (2–25%) was observed with 40–450 μg/L mephedrone, methcathinone, methylone, 4-methylethcathinone (4-MEC), flephedrone (4-fluoromethcathinone), butylone, and methedrone in the OraSure methamphetamine assay. "
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    ABSTRACT: Deterrence of synthetic cathinone abuse is hampered by the lack of a high-throughput immunoassay screen. The Randox Drugs of Abuse V (DOA-V) Biochip Array Technology contains two synthetic cathinone antibodies: Bath Salt I (BSI) targets mephedrone/methcathinone and Bath Salt II (BSII) targets 3’,4’-methylenedioxypyrovalerone (MDPV)/3’,4’-methylenedioxy-α-pyrrolidinobutiophenone (MDPBP). We evaluated DOA-V synthetic cathinones performance and conducted a full validation on the original assay with calibrators reconstituted in water, and the new assay with calibrators prepared in lyophilized urine; both utilized the same antibodies and were run on the fully automated Evidence® Analyzer. We screened 20 017 authentic military urine specimens and confirmed positives by liquid chromatography-tandem mass spectrometry (LC-MS/MS) for 28 synthetic cathinones. Limits of detection (LOD) for the original and new assays were 0.35 and 0.18 (BSI), and 8.5 and 9.2 µg/L (BSII), respectively. Linearity was acceptable (R2 > 0.98); however, a large negative bias was observed with in-house prepared calibrators. Intra-assay imprecision was <20% BSI-II, while inter-assay imprecision was 18-42% BSI and <22% BSII. Precision was acceptable for Randox controls. Cross-reactivities of many additional synthetic cathinones were determined. Authentic drug-free negative urine pH <4 produced false positive results for BSI (6.3 µg/L) and BSII (473 µg/L). Oxidizing agents reduced BSI and increased BSII results. Sensitivity, specificity, and efficiency of 100%, 52.1%, and 53.0% were obtained at manufacturer's proposed cut-offs (BSI 5 µg/L, BSII 30 µg/L). Performance improved if cut-off concentrations increased (BSI 7.5 µg/L, BSII 40 µg/L); however, there were limited confirmed positive specimens. Currently, this is the first and only fully validated immunoassay for preliminary detection of synthetic cathinones in urine. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.
    Drug Testing and Analysis 07/2014; 6(7-8). DOI:10.1002/dta.1633 · 2.51 Impact Factor
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