Read article : Bath salts | Nursing News, Stories & ArticlesAuthor: Nurse.com 
Categories: National 
When Jane Evans, RN, heard a patient was running down the highway to escape the “electricity” pursuing him, she knew this wasn’t an isolated incident but part of a frightening new trend. This spring, Schuylkill Medical Center in Pottsville, Pa., started seeing two or three patients like this per day — people who exhibited psychotic, even violent behavior, yet tested negative on drug screens.
Once calm, these patients admitted to abusing the same product: bath salts. Not a relaxing spa accessory, “bath salt” is a synthetic cathinone called methylenedioxypyrovalerone, packaged under a benign name but specifically made to be abused. Upon ingesting the powdery white substance, users experience euphoria as well as hallucinations, delusions and paranoia.
Bath salt use has exploded nationwide: calls to poison control centers regarding bath salts surged from 303 last year to 4,137 as of July 2011, according to the American Association of Poison Control Centers. Bath salts are sold legally in some states, and manufacturers skirt the law by labeling packets “not for human consumption,” according to Wendy Stephan, health education coordinator, Florida Poison Information Center, Miami. The drug also is cheap. Head shops and websites sell it for $25-$40 under names such as White Rush and Meow Meow.
Given the increase of abuse, nurses across the country who haven’t yet treated patients who have ingested bath salts are likely to do so in the near future.
Identifying bath salt abuse
Bath salts are untraceable in on-site drug screens. So if a patient does not disclose that he or she ingested the substance, it’s up to healthcare providers to identify the symptoms.
The main indicator of bath salt abuse is violent behavior accompanied by paranoid thoughts or hallucinations. “We had one patient throwing mayo stands at the nursing staff because he was hallucinating and thought we were trying to harm him, when we were just trying to help him,” said Gayla St. Onge, RN, certified emergency nurse at Marquette (Mich.) General Hospital. St. Onge co-authored an article about her experiences with patients who had ingested bath salts in the August 2011 Journal of Emergency Nursing.
Chemically, bath salts function similarly to methamphetamine, acting as both a stimulant and a hallucinogen, and causing users to experience restlessness, rapid pulse, sweating, twitching, paranoia, hallucinations and anxiety. The difference is patients who have ingested bath salts report nightmarish trips and, in many cases, exhibit disturbing behavior. “Some cases have involved pretty dramatic instances of self-harm or people attacking others, even loved ones,” Stephan said.
Regarding a visual general assessment, nurses say to look for patients who are behaving frantically. Patients often inject the drug, which irritates the veins, so users often are seen vigorously scratching their skin. “[Patients] were literally gouging themselves at the injection site,” St. Onge said.
Users also are constantly in motion. Because the drug overstimulates metabolism, patients often pick at the air with their hands. Their feet and head are rarely still, either, St. Onge said.
Treatment options
Patients who have ingested bath salts often resist treatment, so patients may have to be sedated using lorazepam. If the patient is exhibiting psychotic behavior, physicians may order haloperidol.
Once able to check the patients’ vital signs, nurses should be on the lookout for tell-tale symptoms of bath salt injection, such as tachycardia, hyperthermia, rapid breathing and dehydration.
There is no specific antidote to bath salts, so supportive care is the best course of treatment, said Evans, who is clinical nurse manager of emergency services. Because patients experience hyperactivity and overheating, nurses may first need to insert an IV to maintain hydration. “People are burning up their fluids and glucose, so … their electrolytes, blood count and blood sugar can often run low,” St. Onge said.
Nurses also should be ready to put patients on cardiac monitors, as the drug elevates users’ heart rates. St. Onge recalls seeing tachycardic patients with heart rates at 100-120 bpm.
In some instances, users have experienced seizures, so St. Onge suggests placing seizure pads on the bed to protect flailing patients from harm. Because stimulation tends to set patients off again, St. Onge and Evans suggest dimming lights, reducing noise and keeping these patients separated from others in the ED.
Once stabilized, patients may be admitted to either the ICU for 24 hours or the psychiatric unit for several days. The drug still is too new to speak conclusively of long-term effects, Evans said. However, bath salts are highly addictive, so some patients may return after further abuse.
Given the drug’s novelty, hospitals nationwide still are figuring out how best to treat these patients. If nurses have any doubts, Stephan recommends calling the Poison Help Line at 800-222-1222.
Future of bath salts
With word about bath salts spreading, many states are moving to declare them illegal. St. Onge’s article describes how, through collaboration between Marquette General staff and local agencies, Marquette County in February declared bath salts a public health hazard and removed them from shelves.
According to St. Onge, nurses should be vigilant about reporting a string of patients with unusual symptoms. “If you’re seeing one patient, OK, but if you’re seeing a third, fourth, or fifth, really pay attention to what’s going on, report cases to Poison Control, and come up with a treatment plan.”
Lauren LeBano is a freelance writer.
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