Over the counter psychoactive “bath salts” (PABS) that contain cardiovascular (CV) and central nervous system (CNS) stimulants are the latest designer drugs sending patients to the emergency department (ED).

Unlike traditional bath salts that are added to bath water for a relaxing soak, these drugs, which can also be ingested, inhaled, or injected, contain CNS stimulants such as 4-methylmethcarhinone (mephedrone) and 3,4 –methylenedioxypyrovalerone (MDPV). Dozens of patients have presented at emergency departments (EDs) with clinical findings consistent with stimulant overdose, many sick enough to require admission, and at least one death on arrival (DOA) has been attributed to MDPV. The most common signs and symptoms were agitation, tachycardia, and delusions or hallucinations.

In one observational study conducted during 2011 by the Children’s Hospital of Michigan Regional Poison Control Center (MPCC; Detroit, USA) of 35 patients presenting to EDs after ingestion, inhalation, or injection of PABS, 32 (91%) had neurologic symptoms, 27 (77%) had CV symptoms, and 17 (49%) had psychological symptoms. Of the 35 patients, 21(63%) had injected the bath salts, 9 (26%) snorted the drug, and 4 (11%) had ingested it. The route of ingestion for five patients, including the one DOA, was unknown.

The principal ingredients in PABS are known as synthetic cathinones, phenylalkylamines derivatives of cathinone, a naturally occurring beta-ketone amphetamine analogue found in the leaves of the Catha edulis plant. Those that are being used as drugs of abuse include butylone, dimethylcathinone, ethcathinone, ethylone, mephedrone, methedrone, MDPV, methylone, and pyrovalerone, and are often termed bk-amphetamines for their beta-ketone moiety.

They may possess both amphetamine-like properties and the ability to modulate serotonin, causing distinct psychoactive effects. Desired effects reported by users of synthetic cathinones include increased energy, empathy, openness, and increased libido. Exposure to and use of synthetic cathinones are becoming increasingly popular despite a lack of scientific research and understanding of the potential harms of these substances. The clinical similarities to amphetamines are predictable, based on the chemical structure of this class of agents. A comprehensive review of the toxicology of bath salts was published early online on November 23, 2011, in the Journal of Medical Toxicology.

Despite growing efforts to ban these products through legislation, PABS often skirt substance-control laws and are readily available at low cost. These products are easily obtained over the Internet under such names as Ivory Wave or Vanilla Sky, and are marketed as producing “a high similar to that obtained with illegal stimulants” such as methamphetamine. They are sometimes referred to as “legal cocaine” (but without causing the pronounced euphoria), as alertness enhancers, or as aphrodisiacs. The risk of overdose is high, since packages contain as much as 500 mg, and some labels suggest escalating the dose to more than 50 mg.

Guangzhou Jia Yu medical equipment Limited