Bath salts: "...synthetic cathinones can result in tachycardia, hypertension, hyperthermia, myocardial infarction, and death."

J Emerg Med. 2014 Feb 22. pii: S0736-4679(13)01430-3. doi: 10.1016/j.jemermed.2013.11.104. [Epub ahead of print]

Synthetic Cathinones ("Bath Salts").

Banks ML1, Worst TJ2, Rusyniak DE3, Sprague JE4.

Author information

• 1Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia.
• 2Ohio Attorney General's Bureau of Criminal Investigation, London, Ohio.
• 3Departments of Emergency Medicine and Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana.
• 4Department of Pharmaceutical Sciences, College of Pharmacy, Ferris State University, Big Rapids, Michigan.

Abstract

BACKGROUND:

Synthetic cathinones are popularly referred to in the media as "bath salts." Through the direct and indirect activation of the sympathetic nervous system, smoking, snorting, or injecting synthetic cathinones can result in tachycardia, hypertension, hyperthermia, myocardial infarction, and death.

OBJECTIVE:

The chemical structures and names of bath salts identified by the Ohio Attorney General's Bureau of Criminal Investigation are presented. Based on their common pharmacophores, we review the history, pharmacology, toxicology, detection methods, and clinical implications of synthetic cathinones. Through the integration of this information, the pharmacological basis for the management of patients using synthetic cathinones is presented.

DISCUSSION:

Synthetic cathinones activate central serotonergic and dopaminergic systems contributing to acute psychosis and the peripheral activation of the sympathetic nervous system. The overstimulation of the sympathetic nervous system contributes to the many toxicities reported with bath salt use. The pharmacological basis for managing these patients is targeted at attenuating the activation of these systems.

CONCLUSIONS:

Treatment of patients presenting after using bath salts should be focused on reducing agitation and psychosis and supporting renal perfusion. The majority of successfully treated synthetic cathinones cases have used benzodiazepines and antipsychotics along with general supportive care.