title: Limb-Threatening Ischemia in a Young Man with Cathinone "Bath Salt" Intoxication: A Case Report.
abstract: "Bath salts" are synthetic designer drugs that have stimulant properties and are a growing medical concern. The chemical compounds in the mixtures have an affinity for receptors in the brain resulting in a stimulant effect similar to that seen with methamphetamines and cocaine. Although illegal in Canada, these drugs are widely available online with over 20 synthetic drugs marketed as "bath salts" and used increasingly among recreational drug users. Much of the medical literature regarding these drugs comes from emergency medicine case reports, which outline the acute, severe medical, and psychiatric effects of "bath salt" toxicity. In this report, we outline severe vascular limb compromise, which occurred in a 24-year-old man who took large doses of bath salts obtained online from China. We detail our experience to re-establish perfusion to the limbs, and the morbidities encountered due to the ischemic insult our patient experienced. The duration and clinical presentation of "bath salt" toxicity are frequently complicated by lack of toxicology screens for the agents on board, and lack of any pharmacokinetic evidence surrounding these synthetic compounds. Although "bath salts" are now illegal in Canada, these drugs are widely available online and have become an increasing public health concern that involves significant morbidity and mortality to users. Creating a base of knowledge and front-line experience are the only current tool in combating the diverse detrimental aftermath of these synthetic agents' abuse.
authors.affiliation: Department of Vascular Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: Asem.saleh@medportal.ca.
authors.forename: Asem
authors.initials: A
authors.lastname: Saleh
authors.affiliation: Department of Vascular Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Tittley
authors.affiliation: Department of Clinical Epidemiology & Biostatistic, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Sonia
authors.initials: S
authors.lastname: Anand
mesh_terms: D000470:Alkaloids / Q000506:poisoning*; D000671:Amputation, Surgical; D003131:Combined Modality Therapy; D003161:Compartment Syndromes / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D000072226:Computed Tomography Angiography; D062787:Drug Overdose; D000071938:Fasciotomy; D005734:Gangrene; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011619:Psychotropic Drugs / Q000506:poisoning*; D012039:Regional Blood Flow; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000470:Alkaloids; D011619:Psychotropic Drugs; D014665:Vasodilator Agents; C023665:cathinone