Bath salts intoxication: a case series.

BACKGROUND: Bath salts commonly contain multiple synthetic drugs, and their toxic effects are largely the same as those seen in patients who have taken large doses of amphetamines. Bath salts can be ingested, smoked, or administered intravenously. Their use is on the rise and is responsible for a large number of emergency department visits. CASE REPORT: Our case series involved five patients (six hospital courses) who presented after ingesting bath salts. The presentations involved signs and symptoms of intense sympathetic response. All patients had a history of drug abuse, and most had psychiatric disorders as well. Treatments included benzodiazepines, mechanical ventilation, and intravenous hydration. CONCLUSION: Bath salts are available for approximately $20 (USD) in packets at truck stops and on the Internet, usually marketed with the disclaimer, "not for human consumption." Their presentation mimics other sympathetic drugs and causes a significant amount of delirium, hallucinogenic-delusional symptoms, extreme agitation, combativeness, and rhabdomyolysis, often leading to hospitalizations and intensive care unit (ICU) stays. Management is largely supportive and includes aggressive intravenous hydration, dampening of the excessive sympathetic outflow with benzodiazepines, and close monitoring in the ICU setting. The U.S. Drug Enforcement Administration (DEA) recently invoked its emergency scheduling authority to control these synthetic stimulants. The DEA plans to make possessing and selling these chemicals, or products that contain them, illegal in the United States.

Foreign body aspiration of a dental bridge in the left main stem bronchus.

Aspiration of tracheobronchial foreign bodies is a life-threatening event that occurs mainly in children. Occurrence in adults is rare and usually has a subtle presentation as most adults are unaware of aspiration of any foreign material. Decreased levels of consciousness, sedation, and neuromuscular diseases are major risk factors for foreign body aspiration in adults. Prompt diagnosis and intervention through foreign body retrieval are critical to prevent significant morbidity and mortality. Retrieval procedure is risky, and sudden decompensation of the patient can occur anytime. We are presenting an adult who accidentally aspirated his dental prosthesis during sleep and underwent successful retrieval of the dental bridge using flexible bronchoscopy.