Bath salts are substance of abuse that are becoming more common and are difficult to recognize due to negative toxicology screening. Acute kidney injury due to bath salt use has not previously been described. We present the case of a previously healthy male who developed acute kidney injury and dialysis dependence after bath salt ingestion and insufflation. This was self-reported with negative toxicology screening. Clinical course was marked by severe hyperthermia, hyperkalemia, rhabdomyolysis, disseminated intravascular coagulation, oliguria, and sepsis. We discuss signs and symptoms, differential diagnoses, potential mechanisms of injury, management, and review of the literature related to bath salt toxicity.

Detection of novel toxins that cause acute kidney injury (AKI) can be a diagnostic challenge, particularly if the manifestations of the toxin mimic those of well-established mechanisms of AKI. An example of this is “bath salt” intoxication, which causes a syndrome that may closely resemble severe sepsis. We report a case of a young adult male who developed severe hyperthermia, rhabdomyolysis, hypotension, leukocytosis, and dialysis-dependent AKI after ingestion and insufflation of bath salts.

Had he not reported the bath salts exposure, confirmed by his family, we would have had no clue to his diagnosis because bath salts are not detected by routine drug screens of the urine or blood. Bath salts are sold legally in many states and are widely available on the Internet. Their properties as synthetic stimulants have led to their widespread abuse. Bath salts can now be added to a list of other substances of abuse associated with acute kidney injury.

Bath salts are synthetic stimulants, sold in head shops and on the internet for up to $120 per gram. Various preparations contain the stimulant designer drugs mephedrone (a.k.a. 4-methylmethcathinone) and MDPV (a.k.a. 3,4-methylenedioxypyrovalerone). Mephedrone is classified as a beta-keto amphetamine. MDPV is structurally related to pyrovalerone, a monoamine reuptake inhibitor.

In summary, we report a case of bath salt use which resulted in severe hyperthermia, hyperkalemia, rhabdomyolysis, shock, DIC, and dialysis-dependent AKI with negative serum and urine drug screen for common toxins. We discuss possible mechanisms of AKI caused by toxic ingestion of bath salts. With increasing use of these substances of abuse and their easy availability, it is important to keep this possibility in differential diagnosis, especially when toxicologic screen is negative.

CONCLUSION

A standard editorial manager system is utilized for manuscript submission, review, editorial processing and tracking which can be securely accessed by the authors, reviewers and editors for monitoring and tracking the article processing.

Manuscripts can be forwarded to the Editorial Office at  kidney@eclinicalsci.org

Media Contact:

John Robert                               
Assistant Managing Editor

Journal of Kidney Treatment and Diagnosis