Bath Salts
Answer: C.
This unfortunate girl was snorting a bath salt. Bath salts may contain a variety of compounds, including MDPV, mephedrone, methylone, naphyrone, or methedrone. They are marketed as “soothing bath salts” which are “not for human consumption”, but are routinely abused and go by various trade names such as Artic [sic] Blast, Ivory Wave, Cloud 9, White Dove, Vanilla Sky, Snow Leopard, etc. They all have in common stimulant effects, acting on norepinephrine, dopamine, and serotonin receptors. The resultant presentation is similar to the familiar sympathomimetic toxidrome. Bath salt intoxications are reported to last up to 12 hours.
In a recent case series of 236 poison center calls for bath salt intoxication, the following features were found:
This unfortunate girl was snorting a bath salt. Bath salts may contain a variety of compounds, including MDPV, mephedrone, methylone, naphyrone, or methedrone. They are marketed as “soothing bath salts” which are “not for human consumption”, but are routinely abused and go by various trade names such as Artic [sic] Blast, Ivory Wave, Cloud 9, White Dove, Vanilla Sky, Snow Leopard, etc. They all have in common stimulant effects, acting on norepinephrine, dopamine, and serotonin receptors. The resultant presentation is similar to the familiar sympathomimetic toxidrome. Bath salt intoxications are reported to last up to 12 hours.
In a recent case series of 236 poison center calls for bath salt intoxication, the following features were found:
Mydriasis can be seen in a variety of toxidromes (A); the mnemonic “SAW” can help to remember: Sympathomimetics, Anticholinergics, and Withdrawal (oh, yes, and GHB – perhaps a modification can be: it WAS the GHB!)
The following table will help to review the most common toxidromes and their features:
The following table will help to review the most common toxidromes and their features:
Here you can see that elevated heart rate is common among toxidromes (B), and that her diaphoresis (C) may help to distinguish the sympathomimetic from the anticholinergic toxidrome.
Although GHB can cause mydriasis, it is characterized by obtundation and/or coma which often resolves precipitously (D).
Treatment with benzodiazepines and IVF is recommended. In severe cases, more aggressive treatment includes dexmedetomidine (often not readily available in the ED, but used in the ICU or OR) and propofol if needed.
Although GHB can cause mydriasis, it is characterized by obtundation and/or coma which often resolves precipitously (D).
Treatment with benzodiazepines and IVF is recommended. In severe cases, more aggressive treatment includes dexmedetomidine (often not readily available in the ED, but used in the ICU or OR) and propofol if needed.