Bath salt intoxication causing acute kidney injury requiring hemodialysis

Abstract

Traditional bath salts contain a combination of inorganic salts like Epsom salts, table salt, baking soda, sodium metaphosphate, and borax that have cleansing properties. Since 2010, there have been rising concerns about a new type of substance abuse in the name of "bath salts." They are beta-ketone amphetamine analogs and are derivates of cathinone, a naturally occurring amphetamine analog found in the "khat" plant (Catha edulis). Effects reported with intake included increased energy, empathy, openness, and increased libido. Serious adverse effects reported with intoxication included cardiac, psychiatric, and neurological signs and symptoms. Not much is known about the toxicology and metabolism of these compounds. They inhibit monoamine reuptake (dopamine, nor epinephrine, etc.) and act as central nervous system stimulants with high additive and abuse potential because of their clinical and biochemical similarities to effects from use of cocaine, amphetamine, and 3,4-methylenedioxy-N-methylamphetamine. Deaths associated with use of these compounds have also been reported. We report a case of acute kidney injury associated with the use of "bath salt" pills that improved with hemodialysis.

Identification of new psychoactive substances (NPS) using handheld Raman spectroscopy employing both 785 and 1064 nm laser sources

“…They are deceitfully marketed to imply legality and safety [2] and often branded with attractive names such as pink champagnes and pink panthers. The abuse of NPS has been linked to violence and aggression [8] , sympathomimetic symptoms [9] ,acute organ failure, [10] psychosis [9] as well as fatalities. [11] At present, the dearth of pharmacological and toxicological knowledge on NPS increases the potential risks and harms to users and greatly impacts treatment decisions.…”

Acute kidney injury requiring haemodialysis following ingestion of mephedrone

“…There are two cases in the literature of AKI following the use of ‘bath salts’ (combination of mephedrone and another stimulant cathinone-derived substance called methylenedioxopyrrovalerone),10 11 although the patient required dialysis treatment in only one of these 11. As in this case, rhabdomyolysis may have contributed, but was unlikely to explain the degree of AKI because the CK concentration was not very high.…”

“…Adebamiro et al 10 speculated that these synthetic cathinones cause renal arteriolar vasospasm, leading to renal ischaemia and acute tubular necrosis (ATN). This mechanism has been proposed by others, mainly based on the close structural and pharmacological relationship between mephedrone and substances such as ecstasy and amphetamine 11 12. Mephedrone may also be directly nephrotoxic, leading to ATN 10.…”

“…Mephedrone may also be directly nephrotoxic, leading to ATN 10. All cases reported have either developed mild AKI or have recovered kidney function with dialysis treatment 11. Regunath et al 11 suggested that the low molecular weight of mephedrone would permit its removal by dialysis.…”

Comprehensive Forensic Toxicological Analysis of Designer Drugs

“…Many individuals have presented to emergency departments and hospitals with severe intoxications. Reports have characterized the more dangerous effects, including suicidal and homicidal ideations (12) , psychosis (4,16) , acute kidney injury (13,28) , multi-organ failure (29) , seizures (18) , and Serotonin Syndrome (18) . With regard to fatal intoxications, case reports include cause of death such as disseminated intravascular coagulation (30,31) , anoxic encephalopathy (31) , cardiac arrest (31) , acute kidney failure (32) , and lethal Serotonin Syndrome.…”