Download Calgon, take me away….

7/24/2014
Objectives
• Discuss the epidemiology of bath salt poisonings
• Review toxicological facets
Bath Salts, Coming To Your Town…
• Identify current marketed street identities
• Expose symptomatologies
• Discuss current therapeutic modalties
Expect the Unexpected….
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7/24/2014
“The Tennessee Bureau of Investigation said Rogers is a truck
driver. They believe he picked Nelms in Knoxville, killed her,
then dumped her body”.
“The medical examiner's preliminary autopsy revealed that
Nelms died of multiple blunt force trauma and stab wounds”
Bath Salts – As Intended…
Epsom Salt
The Most Studied Bath Salt
• The earliest systematic exposition of the different kinds
of salts, its uses, and the methods of its extraction was
published in China around 2700 years BC.
• Bath salts provide a variety of benefits to a bather. Salts
change the osmotic balance of the water so that less water is
absorbed by the skin via osmosis. This reduces the
"pruning" or "wrinkling" effect of prolonged exposure of
skin to fresh water.
• Hippocrates encouraged his fellow healers to make use
of salt water to heal various ailments by immersing their
patients in sea water. The ancient Greeks continued this,
and in 1753 English author and physician Dr. Charles
Russel published "The Uses of Sea Water
• Some bath salts such as phosphates have a detergent action
which softens calloused skin and aids in exfoliation.
• High concentrations of salts increase the density of the
water and increase buoyancy which makes the body feel
lighter in the bath. Very high concentrations of salts in water
are used in flotation therapy.
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7/24/2014
Bath Salts…
The “New” Bath Salts…
• Appearance
• Free base form (possibly)
• Dirty or tan (copper colored) powder
• “Pure” form
• White powder
• Possibly the HCl salt form
• Odorless
• Resembles baby powder or flour
Bath Salts…
Bath Salts - What Are They???
• Drugs that contains 3,4-methylenedioxypyrovalerone (MDPV) and may be
combined with mephedrone
• Mephedrone
• Derivative of methcathinone
• Stimulant derived from the Khat plant
• MDPV
• Belongs to a class of compounds referred to as beta ketones sold as “research
chemicals”
• Highly potent pyrovalerone analogue
• Developed in the 1960’s and was used to treat fatigue and lethargy and used as an anorectic
• Now a Schedule V controlled substance
• Abuse and Dependence
“Synthetic drugs that contain a variety of stimulant
and hallucinogenic compounds”
• Availability:
• Convenience stores, discount stores, tobacco outlets, gas
stations, pawnshops, tattoo parlors, truck stops, smoke shops
and internet
• Sold in 50mg – 500mg packets
• Price:
• $25 - $50 per 50mg packet
• Dose:
• 5mg-20mg
• Redosing is common
• Up to 200mg has been reported
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7/24/2014
Products that may be currently
marketed as “Bath Salts”…
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•
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•
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Arctic Blast
Cloud 9
Disco Bath Salt
Hurricane Charlie
Ivory Wave
Lunar Wave
Mamba
Snow Leopard
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•
•
•
•
•
•
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Tranquility
Vanilla Sky
Zoom
White Rush
Ocean Burst
Sky Blitz Premium
Sextacy
UP Powder
Symptomatologies…
(can be variable)
• Agitation
• Paranoia
• Choreoathetoid
movements
• Psychosis
• Hallucinations
• Hypertension
• Hyperthermia
• Rhabdomyolysis
• Renal Failure
• Tachycardia
http://www.youtube.com/watch?v=CjrxXpgjp4I&feature=related
Bath Salts:
Mechanisms of Introduction
• Inhalation
• Most common
• Orally
• Capsules
• “Bombing” – wrap it up in cigarette papers and swallow
• Smoking
• Rectally
• Mix with water
• IV
What effects will it have of my patient?
• MOAI
• Inhibits the reuptake of dopamine and norepinephrine
• No effect on serotonin levels
• ADME (Absorption, Distribution, Metabolism, and Excretion)
• Peak affect occurs around 90 minutes
• “Come down” occurs around hour 2.5
• Lasts approximately 1 hour
• Patient stories state otherwise
• Many patients report adverse effects lasting for days
• Panic attacks and prolonged anxiety may occur at higher doses and with regular use
• Non-oral forms
• May peak earlier
• May be shorter acting
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7/24/2014
Yet more…
• Clinical effects
Therapeutic Modalities
• High dose benzodiazepines to control agitation
• Dose dependent
• Lower doses - methylphenidate like effects (psychostimulant)
• Higher doses – cocaine and amphetamine like effects
• Patient experience states > dose, > +/- effects
• Desired effects
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•
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Stimulant
Increased energy
Sociability
Euphoria
Increased concentration
Aphrodisiac effects
Toxicology Testing
• Active measures to keep cool if the patient becomes
hyperthermic
– Sedation, cooling blankets, cool IV fluids, ice packs, and
ultimately chemical paralysis with sedation
• Aggressive fluid resuscitation due to (1) increased losses,
and (2) potential for rhabdomyolysis
• Consultation with a Medical Toxicologist
Collect a Red Top Vacutainer
• There are NO standard drug screens that can detect the
presence of the numerous synthetic drugs that comprise
“bath salts”
• NMS Labs based out of Willow Grove, PA is staying
current with the availability of trends and can test for all
compounds found in the “bath salts” product.
• Testing is optional but can help differentiate between
psychotic break and drug effect, as well as helping
correlate symptoms with a specific compound.
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7/24/2014
The Legal Perspective
• Legal status
• Currently no federal laws against its use
• States independently are passing emergency bills to
ban both MDPV and mephedrone
MDPV
• North Carolina
Mephedrone
• March 16th a bill classifying MDPV and mephedrone as a
schedule 1 controlled substance was ratified and passed
• June 1st the law will go into effect
In Summary
• Morbidity and mortality rates are hastily
increasing secondary to these toxic
compounds!
• Unexplained bizarre behavior or movements
should raise your index of suspicion that bath
salts are onboard.
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7/24/2014
Poison Control Center
THANK YOU!!!!
1-800-222-1222
Works Cited
•
Carolinas Poison Center: Laboratory testing for “Bath Salts” or “Plant Food”
•
K2 and Bath Salts Talk: author - Nicole Abolins, Pharm.D.
•
http://www.austincc.edu/mlt/phb_tubes
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http://www.buffalonycriminaldefenselawyer.com/2011/01/calgon-take-me-awaybath-salts-used-as-fake-cocaine.shtml
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http://en.wikipedia.org/wiki/Bath_salts
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