Disclosures No financial disclosures I have never consumed bath - PowerPoint PPT Presentation

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 case that started it all… 1

11/4/2013 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 2

11/4/2013 Methylone Mephedrone MDPV Catha edulis (“Khat”) 3

11/4/2013 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? 4

11/4/2013 Severe Toxicity • Psych: Agitated delirium, psychosis x 10 + • CNS: Seizure, cerebral edema • Cardiovascular: Myocardial ischemia, Sympathomimetic Serotonin hemodynamic collapse • Renal: Rhabdomyolysis, AKI • Hyperpyrexia •Agitation, seizure •Tachycardia, HTN •Hyponatremia •Mydriasis, diaphoresis •Hallucination 259 exposures 213 age 13-39 50% ingested 33% insufflated 29 (11%) admitted to non-ICU 22 (9%) admitted to psych Seizure, coma, death. 219 referred to ED 15 (6%) intubated 35 (14%) admitted to ICU 86 (33%) discharged 2 (1%) died 5

11/4/2013 1379 (88.5%) intentional abuse 2,018 exposures 956 (58.5%) received BZD 1,633 included 142 (8.7%) intubated 253 (15.5%) “major effect” 9 (0.6%) died Diagnosis What can you do about it? • History and physical exam • Fingerstick glucose • Laboratory testing • ECG and monitoring 6

11/4/2013 Review: Three Answers Therapy • ABC’s • What are “Bath Salts?” • Aggressive cooling • What do patients on Bath Salts look like? • What can you do about it? • Benzodiazepines • Antipsychotics? • Dantrolene? Acknowledgements and References • Thanks – Craig Smollin, MD – Kent Olson, MD Thank You • 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. 7