Case Report
Recurrent Acute Kidney Injury Following Bath Salts Intoxication

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“Bath salts” are becoming recognized as a frequently abused and highly addictive substance that can be obtained legally in some areas. These agents contain stimulant compounds, such as methylenedioxopyrrovalerone and mephedrone, that have been associated with sympathomimetic effects and psychotic features, such as paranoia, delusions, agitation, and confusion. They may have a benign course; however, intoxication with these agents may lead to severe cardiovascular and neurologic complications and death. We report a case of recurrent acute kidney injury associated with repeated bath salts intoxication. The patient, who presented with neurologic and cardiovascular symptoms and signs, also developed rhabdomyolysis, hyperuricemia, and metabolic acidosis as part of the clinical presentation. Bath salts intoxication should be included on the list of substances that can cause acute kidney injury and other metabolic abnormalities.

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Case Report

A 26-year-old man presented twice with bath salts ingestions. On the first presentation, the patient was behaving strangely, with paranoia, confusion, and agitation. Upon treatment with sedatives and antipsychotics, the patient became calm after several hours. He was hypertensive and tachycardic, but there were no obvious abnormal physical findings on examination. Laboratory tests showed an elevated serum creatinine level and other laboratory test result abnormalities (Table 1). Urine and serum

Discussion

A relatively new type of substance abuse that is on the rise in the United States is the use of bath salts. Unlike traditional cosmetic bath salts, which are marketed and sold as additives to bath water for relaxation, these agents are intended solely for the purpose of substance abuse.2 This product most often is a crystal, but also may come in powder form. The package label contains the warning “not for human consumption” and they sometimes are marketed and sold as plant food, pond scum

Acknowledgements

Support: None.

Financial Disclosure: The authors declare that they have no relevant financial interests.

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Originally published online November 28, 2011.

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Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.