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11/4/2013 Disclosures No financial disclosures I have never consumed bath salts Rub-A-Dub-DIE: Bath Salts in the ED Eric Silman, MD Assistant Professor of Emergency Medicine UCLA Medical/Olive-View Emergency Medicine Residency The

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Rub-A-Dub-DIE: Bath Salts in the ED

Eric Silman, MD

Assistant Professor of Emergency Medicine

UCLA Medical/Olive-View Emergency Medicine Residency

Disclosures

No financial disclosures
I have never consumed bath salts

The case that started it all…

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Objectives: Three Questions

What are Bath Salts?
What do patients on Bath Salts look like?
What can you do about it?

What Are Bath Salts? What Are Bath Salts?

Synthetic Cathinones

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Methylone Mephedrone MDPV

Catha edulis (“Khat”)

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History and Legality

Early 2000’s: Europe
2010: First US reports
2011: DEA Schedule I
2012: Federal Ban
“Designer Drug” concept
Federal Analog Act

What do patients on Bath Salts look like?

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+

x 10

Sympathomimetic

Agitation, seizure
Tachycardia, HTN
Mydriasis, diaphoresis

Serotonin

Hyperpyrexia
Hyponatremia
Hallucination

Severe Toxicity

Psych: Agitated delirium, psychosis
CNS: Seizure, cerebral edema
Cardiovascular: Myocardial ischemia,

hemodynamic collapse

Renal: Rhabdomyolysis, AKI

Seizure, coma, death.

259 exposures

213 age 13-39 50% ingested 33% insufflated

219 referred to ED 86 (33%) discharged

15 (6%) intubated 29 (11%) admitted to non-ICU 22 (9%) admitted to psych 35 (14%) admitted to ICU 2 (1%) died

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2,018 exposures 1,633 included

142 (8.7%) intubated 1379 (88.5%) intentional abuse 956 (58.5%) received BZD 253 (15.5%) “major effect” 9 (0.6%) died

What can you do about it? Diagnosis

History and physical exam
Fingerstick glucose
Laboratory testing
ECG and monitoring

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Therapy

ABC’s
Aggressive cooling
Benzodiazepines
Antipsychotics?
Dantrolene?

Review: Three Answers

What are “Bath Salts?”
What do patients on Bath Salts look like?
What can you do about it?

Acknowledgements and References

Thanks

– Craig Smollin, MD – Kent Olson, MD

Selected references

Fass JS, Fass AD, Garcia AS. Synthetic cathinones (bath salts): legal status and patterns of abuse. Ann

Pharmacotherapy. 2012 Mar 46: 436-41.

Warrick BJ et. al. Synthetic cathinones a 9-state analysis of designer stimulant “Bath Salts.” Ann Emerg Med 2013.