"Bath Salts" what do you know about it?

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sevoflurane

sevoflurane

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20+ Year Member
Apparently “bath salts” are being used as a cheap way to get high. Until recently, I never even heard of bath salts. Acute psychosis is a potential sequelae.

I find this case very disturbing and wonder what implications it may have in the OR.

Scary stuff.

http://abcnews.go.com/US/miami-face...nizing-minutes/story?id=16458696#.T84ehO0qNdg

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man-eats-face-in-miami-pictures.jpg
 
All I know is that bath salts are just being scapegoated to divert our attention from the coming zombie apocalypse...
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the "bath salts" being used to get high are not the "bath salts" that you think of, they are labeled that way (i.e. "not for human consumption") to skirt some laws, but i think the drug is mephedrone, a fairly potent stimulant in the vein of methamphetamine and perhaps with more psychotropic effects. a colleague of mine had a patient present admitting to using bath salts in the last 24 hours, i think he treated it like cocaine use and put him off for another day.
 
Sevo

I was going to post this Sevo, but you beat me to it. It's obviously a lot of news down here in Florida and especially with friends working at Jackson. I don't know, it's brutally scary, I've read that most often the users are naked because of extreme heat (metabolic process?) due to the drug. Clearly, I now have to talk to my young kids about "bath salts" so that they know these are not the usual bath salts, and another horrible drug not to be messed with.

I'd never scene those photos of the homeless man, that's really sad.

Apparently, the drug is this: (as named by Idiopathic above). In Canada they are banning this drug due to the Miami case, or at least some legislation is on the way.

http://en.wikipedia.org/wiki/Methylenedioxypyrovalerone

D712
 
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I had never seen the pics either. I heard the poor guy was messed up pretty bad, but I never imagined it was as bad as that. That is horrific. Did they just release the photos? I figured they would not release them.
I have a pretty strong stomach, but that is really bad.
 
Gern Blansten said:
I had never seen the pics either. I heard the poor guy was messed up pretty bad, but I never imagined it was as bad as that. That is horrific. Did they just release the photos? I figured they would not release them.
I have a pretty strong stomach, but that is really bad.
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I wonder which former health care worker is now looking for another line of work after taking and releasing that photograph.

I doubt that this victim was capable of consenting to his photograph being published. Being homeless, the odds of consent coming from next of kin or a responsible person with POA seem low.
 
Yeah, I heard about this. I was hoping I could avoid seeing these pictures.

I think the manufacturers of "bath salts" should be held responsible. Absolutely no reason for the existence of such a product. The "bath salts" used as drugs are vastly different from the crap women throw in their bubble bath.
 
Any time there is a new way to get high I end up seeing it in the ICU.

First it was marijuana soaked in embalming fluid (formaldehyde) or PCP. This led to a very toxic psychosis that has lasted over a month for some. Had many reports in local news about funeral homes being robbed.

Then it became Bath Salts causing horrible AMS

Now it is G20 potpurri, essentially can cause the type of psychosis as the weed in embalming fluid.

Cant wait to see what these *****s use next to try and get high
 
Cottonmouth venom and meth was a case at my med school. Some meth cooks had heard through the grapevine that if you shot cottonmouth venom with your meth, it would augment the high. What it did do was buy them an ICU stay for 24 hours before dying.
 
seinfeld said:
Any time there is a new way to get high I end up seeing it in the ICU.

First it was marijuana soaked in embalming fluid (formaldehyde) or PCP. This led to a very toxic psychosis that has lasted over a month for some. Had many reports in local news about funeral homes being robbed.

Then it became Bath Salts causing horrible AMS

Now it is G20 potpurri, essentially can cause the type of psychosis as the weed in embalming fluid.

Cant wait to see what these *****s use next to try and get high
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Those are two very different drugs with different pharmacology and mechanisms of action, the potpourri and PCP I mean. Just saying, for what it's worth.
 
scudrunner said:
Yeah, I heard about this. I was hoping I could avoid seeing these pictures.

I think the manufacturers of "bath salts" should be held responsible. Absolutely no reason for the existence of such a product. The "bath salts" used as drugs are vastly different from the crap women throw in their bubble bath.
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Dateline or 20/20 interviewed one undercover about a year ago. IIRC he admitted that if they made the chemical illegal, he could change the formula a little bit and have new stuff that was legal out in a week. Move a hydrogen around here or there and you create a new chemical and the way state/federal drug laws work it wouldn't be outlawed.
 
Mman said:
Dateline or 20/20 interviewed one undercover about a year ago. IIRC he admitted that if they made the chemical illegal, he could change the formula a little bit and have new stuff that was legal out in a week. Move a hydrogen around here or there and you create a new chemical and the way state/federal drug laws work it wouldn't be outlawed.
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Clearly the solution is more complicated drug laws. 🙂
 
This is very much my department.

These are essentially amphetamine derivatives (grossly, as that is eliminates all subtlety). Most of the so called "bath salts" (also sold as iPhone cleaner, Jewelry cleaner, plant food and more) are substituted on the phenyl ring and have a significant amount of serotonin agonism. Some of the newer ones have more substitution of the amine side and show more epinephrine/dopamine agonism.

We have been recommended aggressive benzodiazepine therapy with small doses of barbs as a back up. These patients can often take anesthesia sized doses without too much difficulty. Propofol would probably also work, however I'd prefer not to use it as monotherapy. There may be a role for haloperidol in the truly psychotic patient but I would absolutely not use it as monotherapy and I'd only add it after I'd given a few rounds of large doses benzos.

The potpourri stuff is basically crap potpourri that has been laced with synthetic cannabinoid agonists. These drugs are potent agonists, unlike THC which is actually a mixed agonist/antagonist. The new bad boy, AM-2201, seems to have a higher incidence of seizure, when compared to the older ones (which have been banned), like JWH-018. The patient frequently present psychotic with a significantly sympathomimetic picture. Treatment is the same...benzo, benzo, benzo.
 
I've dealt with patients who have OD in bath salts a couple of times in the ICU. Luckily for them, they were relatively healthy, 18-20 year old kids. They are usually hypertensive, confused, and actively hallucinating. Sometimes they become combative and need to be restrained. After chilling out for a day or two in the unit on ativan, they were usually sent to the psych floor to spend a night before being discharged home.


As far as the pics in the opening thread, I don't know if that was the actual victims face, but I heard that there were violations and the hospital was doing an internal investigation after the patient's picture was leaked.
 
Everything I know is from Chris Hansen's Dateline NBC episode. And why is there a naked guy on this thread?
 
DreamMachine said:
Everything I know is from Chris Hansen's Dateline NBC episode. And why is there a naked guy on this thread?
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Was listening to EMRAP (an EM podcast) and they had their tox guy discussing bath salts. He was theorizing that the problem is that people haven't work out the right dosage so the effects are ranging from increased energy + mild tripping to sympathomimetic induced MI and face eating. Some of the same issues with the potpourri (it went by Spice in TN)
 
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