SESSION TYPE: Miscellaneous Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Psychoactive “bath salts” are a relatively new group of designer drugs that mimic the effects of substances like cocaine and methamphetamine. Although cardiovascular complications have been reported, respiratory consequences of their use are not well described.
CASE PRESENTATION: We report the case of a 43-yo-male with history of obesity, hypothyroidism, diabetes, hypertension and chronic obstructive pulmonary disease (COPD) who presented with altered mental status and hypoxia. Symptoms of dyspnea, agitation followed by obtundation progressed rapidly over a period of 24 hours. There were no preceding symptoms or illness. He was admitted to the intensive care unit and diagnosed with acute respiratory distress syndrome (ARDS) with the presence of hypoxia and bilateral pulmonary infiltrates. He required non-conventional ventilation with airway pressure release ventilation (APRV), inhaled epoprostenol and systemic steroids for refractory hypoxemia. Thorough diagnostic investigation was performed including multiple body fluid cultures, bronchoalveolar lavage, toxicology screen and respiratory viral panel. They were all unrevealing. There was no history of exposures. However eventually a family member reported that patient had been inhaling “bath salts” right before his illness. Little was known about “bath salts” by our team and further investigation revealed that they were the likely cause of his ARDS.
DISCUSSION: “Bath salts” are stimulants that were sold as tablets, capsules, or powder and easily purchased in places such as convenience stores, gas stations, and the Internet. The most common are mephedrone and methylone. The drugs cause intense stimulation, and symptoms may include euphoria, pleasurable "rush", tachycardia, and hypertension. They are not detected on common drug screens making it difficult to be identified without a history of use. The prevalence of use increased in the United States in the past 2 years. Several adverse events were reported including deaths. U.S. Drug Enforcement Administration recently named the key ingredients in “bath salts” as Schedule I, thereby making them illegal to possess or sell in the United States.
CONCLUSIONS: This case illustrates the potential severe respiratory complications caused by drugs called “bath salts”. High index of suspicion is necessary as they are not detected with common drug screens.
1) Fass JA, Fass AD, Garcia AS. Synthetic Cathinones (Bath Salts): Legal Status and Patterns of AbuseThe Annals of Pharmacotherapy 2012 March, Volume 46, 436-441
DISCLOSURE: The following authors have nothing to disclose: Humberto Choi, Manuel Ribeiro Neto
No Product/Research Disclosure InformationCleveland Clinic Foundation - Respiratory Institute, Cleveland, OH