"Bath salt" ingestion leading to severe intoxication delirium: two cases and a brief review of the emergence of mephedrone use.
ABSTRACT 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: http://www.nida.nih.gov/about/welcome/MessageBathSalts211.html. Accessed March 25, 2011; The Washington Post. Available at: http://www.washingtonpost.com/national/officials-fear-bath-salts-becoming-the-next-big-drug-menace/2011/01/22/ABybyRJ_story.html. 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.
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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ABSTRACT: Psychostimulants are a diverse group of substances with their main psychomotor effects resembling those of amphetamine, methamphetamine, cocaine, or cathinone. Due to their potential as drugs of abuse, recreational use of most of these substances is illegal since 1971 Convention on Psychotropic Substances. In recent years, new psychoactive substances have emerged mainly as synthetic cathinones with new molecules frequently complementing the list. Psychostimulant related movement disorders are a known entity often seen in emergency rooms around the world. These admissions are becoming more frequent as are fatalities associated with drug abuse. Still the legal constraints of the novel synthetic molecules are bypassed. At the same time, chronic and permanent movement disorders are much less frequently encountered. These disorders frequently manifest as a combination of movement disorders. The more common symptoms include agitation, tremor, hyperkinetic and stereotypical movements, cognitive impairment, and also hyperthermia and cardiovascular dysfunction. The pathophysiological mechanisms behind the clinical manifestations have been researched for decades. The common denominator is the monoaminergic signaling. Dopamine has received the most attention but further research has demonstrated involvement of other pathways. Common mechanisms linking psychostimulant use and several movement disorders exist.Frontiers in Neurology 04/2015; 6:75. DOI:10.3389/fneur.2015.00075
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ABSTRACT: The new recreational designer drugs known as “bath salts” are synthetic cathinones (e.g., mephedrone, 3,4-methylenedioxypyrovalerone, methylone) that are being abused as stimulants. Bath salts have similar effects as amphetamine, cocaine, and MDMA (3,4-methylenedioxymethamphetamine, also known as ecstasy). Cathinone is a naturally occurring phenylalkylamine alkaloid present in the khat plant that has been used for centuries, but in Western countries, they are primary used by “young clubbers.” In this review, the pharmacology and neurotoxicity of bath salts will be discussed and the prevalence and pattern of bath salt use will be presented. The U.S. Poison Control Center received an increasing number of calls regarding bath salt intoxication in 2011, which led to an emergency temporary ban in September 2011. Despite the ban, the use of bath salts has continued. Multiple reports have described the clinical features of bath salt intoxication and withdrawal symptoms, as well as the potential for abuse and the development of dependence. There are reports of bath salts causing hallucinations, delirium, and psychosis. For patients presenting with bath salt intoxication, management includes using medications for behavioral control and other symptomatic support. In this review, we will report the use of bath salts in a patient with a history of schizophrenia and comorbid methamphetamine dependence. His clinical course will be discussed. In order to prevent the further abuse of bath salts, we need to encourage the continuing ban on the sale of bath salts and also educate both clinicians and patients about the risks of using such drugs.Journal of Dual Diagnosis 07/2012; 8(3):250-256. DOI:10.1080/15504263.2012.697447 · 0.80 Impact Factor
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ABSTRACT: Overdose of amphetamine, related derivatives, and analogues (ARDA) continues to be a serious worldwide health problem. Patients frequently present to the hospital and require treatment for agitation, psychosis, and hyperadrenegic symptoms leading to pathologic sequelae and mortality. To review the pharmacologic treatment of agitation, psychosis, and the hyperadrenergic state resulting from ARDA toxicity. MEDLINE, PsycINFO, and the Cochrane Library were searched from inception to September 2014. Articles on pharmacologic treatment of ARDA-induced agitation, psychosis, and hyperadrenergic symptoms were selected. Evidence was graded using Oxford CEBM. Treatment recommendations were compared to current ACCF/AHA guidelines. The search resulted in 6082 articles with 81 eligible treatment involving 835 human subjects. There were 6 high-quality studies supporting the use of antipsychotics and benzodiazepines for control of agitation and psychosis. There were several case reports detailing the successful use of dexmedetomidine for this indication. There were 9 high-quality studies reporting the overall safety and efficacy of β-blockers for control of hypertension and tachycardia associated with ARDA. There were 3 high-quality studies of calcium channel blockers. There were 2 level I studies of α-blockers and a small number of case reports for nitric oxide-mediated vasodilators. High-quality evidence for pharmacologic treatment of overdose from ARDA is limited but can help guide management of acute agitation, psychosis, tachycardia, and hypertension. The use of butyrophenone and later-generation antipsychotics, benzodiazepines, and β-blockers is recommended based on existing evidence. Future randomized prospective trials are needed to evaluate new agents and further define treatment of these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.Drug and Alcohol Dependence 02/2015; 150. DOI:10.1016/j.drugalcdep.2015.01.040 · 3.28 Impact Factor