"Bath salts" are the latest designer drugs sending patients to the emergency department (ED). Unlike traditional bath salts that are added to bath water for a relaxing soak, these drugs, which can be ingested, inhaled, or injected, contain cardiovascular and central nervous system (CNS) stimulants such as 3,4 –methylenedioxypyrovalerone (MDPV) or 4-methylmethcarhinone (mephedrone). The drugs were initially sold over-the-counter under a number of different names. Patients using the drugs present to the ED with signs of acute stimulant overdose.
The Michigan Poison Control Center (MPCC) did a study of patients presenting to EDs after ingestion, inhalation, or injection of "bath salts" from November 2010 through March 2011. Data was collected on patient characteristics, presenting symptoms, clinical findings, treatment, and patient disposition.
A total of 35 patients presenting to Michigan EDs after abusing "bath salts," including 3 with repeat visits, were reported to the MPCC during the reporting period. The patients were 20-55 years of age, with a median of 28 years. Nineteen of the patients (54%) were male. Sixty-nine percent had a history of drug abuse and nearly half had a history of mental illness.
Clinical findings were consistent with stimulant overdose. The most common signs and symptoms were agitation, tachycardia, and delusions/hallucinations. Thirty-two patients (91%) had neurologic symptoms, 27 (77%) had cardiovascular symptoms, and 17 (49%) had psychological symptoms. Twenty-one patients (63%) injected "bath salts," nine (26%) snorted the drug, and 4 (11%) ingested it. The route of ingestion for five patients, including the one DOA, was unknown.
Stimulant drug overdose, although not usually life threatening, is associated with increased morbidity and mortality. These patients are more prone to be involved in accidents. These patients also act in a bizarre manner, not unlike other stimulant overdoses, and when confronted by police will not follow orders or directions. This often leads to the excessive use of an electrical device like TASER, and in-custody death.