UMEM Educational Pearls

Category: Toxicology

Title: Not your ordinary Bath product

Keywords: Bath salts, mephedrone, agitated delirium (PubMed Search)

Posted: 7/31/2014 by Kishan Kapadia, DO
Click here to contact Kishan Kapadia, DO

Bath salts (synthetic cathinones) commonly contain multipe synthetic drugs and can be ingested, smoked, or administered intravenously.  The designer stimulant mephedrone (4-methylcathinone) is among the most popular of the derivatives of the naturally occurring psychostimulant cathinone.  Bath salt use is on the rise and is responsible for a large number of ED visits.

In spite of their ban, bath salts are still available over the counter in specialty shops and through the Internet with common product names such as: "Ivory Wave," "Cloud 9," "Purple Wars," "Vanilla Sky," "Bliss," etc.  They are commonly marketed with the disclaimer, "not for human consumption.

Their presentation mimics other sympathetic drugs through pathways similar to amphetamines.  The primary psychological effects have a duration of roughly 3-4 hours, with physiologic effects lasting from 6-8 hours.

Physical Effects                        Behavioral & Mental Status Effects
Tachycardia Agitation
Hypertension Paranoia
Dysrhythmias Hallucinations
Hyperthermia Psychosis
Seizures Violent behavior
Sweating Delusions

Management is largely supportive and includes IV hydration, benzodiazepines, and close monitoring in the ICU setting.



Imam SF, Patel H, Mahmoud M, Bath salts intoxication: A case series. JEM 2013;45(3):361-365.