title: Bath salts intoxication: a case series.
abstract: BACKGROUND
  Bath salts commonly contain multiple synthetic drugs, and their toxic effects are largely the same as those seen in patients who have taken large doses of amphetamines. Bath salts can be ingested, smoked, or administered intravenously. Their use is on the rise and is responsible for a large number of emergency department visits.
  
  
  METHODS
  Our case series involved five patients (six hospital courses) who presented after ingesting bath salts. The presentations involved signs and symptoms of intense sympathetic response. All patients had a history of drug abuse, and most had psychiatric disorders as well. Treatments included benzodiazepines, mechanical ventilation, and intravenous hydration.
  
  
  CONCLUSIONS
  Bath salts are available for approximately $20 (USD) in packets at truck stops and on the Internet, usually marketed with the disclaimer, "not for human consumption." Their presentation mimics other sympathetic drugs and causes a significant amount of delirium, hallucinogenic-delusional symptoms, extreme agitation, combativeness, and rhabdomyolysis, often leading to hospitalizations and intensive care unit (ICU) stays. Management is largely supportive and includes aggressive intravenous hydration, dampening of the excessive sympathetic outflow with benzodiazepines, and close monitoring in the ICU setting. The U.S. Drug Enforcement Administration (DEA) recently invoked its emergency scheduling authority to control these synthetic stimulants. The DEA plans to make possessing and selling these chemicals, or products that contain them, illegal in the United States.
authors.affiliation: Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA.
authors.forename: Syed F
authors.initials: SF
authors.lastname: Imam
authors.forename: Hetalben
authors.initials: H
authors.lastname: Patel
authors.forename: Monay
authors.initials: M
authors.lastname: Mahmoud
authors.forename: Nisha A
authors.initials: NA
authors.lastname: Prakash
authors.forename: Matthew S
authors.initials: MS
authors.lastname: King
authors.forename: Richard D
authors.initials: RD
authors.lastname: Fremont
mesh_terms: D000328:Adult; D000374:Aggression; D017109:Akathisia, Drug-Induced / Q000209:etiology; D001569:Benzodiazepines / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D015198:Designer Drugs / Q000506:poisoning*; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning*; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D011041:Poisoning / Q000628:therapy
chemical_list: D000697:Central Nervous System Stimulants; D015198:Designer Drugs; D013287:Illicit Drugs; D001569:Benzodiazepines
keywords: Bliss; Ivory Wave; Vanilla Sky; agitated delirium; bath salts; mephedrone; stimulant overdoses; toxicology