Not all bath salts are about rest and relaxation. One of the newer kids on the block in the illicit drug market are so called “bath salts” – the fancy name being Mephedrone and MDPV. Both are β-ketophenethylamine derivatives of cathinone, a compound from the plant Catha edulis. Common street names for Mephedrone are plant food, MCAT, 4-MMC, meow meow, meph, and drone. MDPV is commonly called MTV, MDPK, Magic, and Super Coke. Both of these compounds are structurally similar to amphetamine. Mephedrone has close similarities with methamphetamine and MDPV with ecstasy. Bath salts pose an increasing public health risk in the United States, with increasing reports of toxicity and mortality. The crystalline powder is generally white or tan and most commonly ingested or snorted nasally. Although the exact mechanism of action is not fully known, research has indicated that norepinephrine and dopamine reuptake inhibition are likely prominent in MDPV and mephedrone, therefore resulting in a sympathomimetic toxidrome similar to cocaine, methamphetamine, and ecstasy. Features typical of the bath salt toxidrome include, altered mentation and sensorium, agitation, tachycardia, hypertension, and hyperthermia. Unfortunately standard urine drug screens will not pick up these drugs therefore clinical suspicion should be high in the patient who presents with these symptoms and suspected ingestion. So what’s the treatment for someone you suspect to have bath salts overdose? Well much as you would do for an amphetamine overdose:
- assess your airway, breathing and circulation
- First line therapy to control agitation is benzodiazepines
- Fluid management
- Temperature control, may play significant roles in individual cases.
- Seizures, should they occur, should be managed with your typical ER anti-epileptic medications such as benzodiazepines, barbiturates, and propofol.
So the moral of the story… another thing to keep on your radar on those crazy night shifts in the ER.