Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Bath Salt Abuse – EMS Garage Episode 140 – Part I

This week’s EMS Garage[1] covered paramedics being highly respected in Australia and the abuse of bath salts.

Bath salts ingestion can lead to rhabdomyolysis, which is primarily a blockage of the kidneys with the byproducts of tissue destruction. What is most dangerous about rhabdomyolysis is the release of large amounts of potassium into the blood stream. A poisonous amount of potassium is called is hyperkalemia and some of us may have a protocol by the names of crush syndrome, rhabdomyololysis, or hyperkalemia.

Management of severe hyperkalemia.[2] Click on the image to make it larger.

Hyperkalemia can be treated quickly with calcium gluconate or calcium chloride. Another treatment that works quickly is albuterol. Some protocols be limited to treatment with sodium bicarbonate (NaHCO3), but this works much more slowly than calcium or albuterol. The difference in time between calcium and bicarb is a lifetime – the patient’s remaining lifetime.

Call medical command for permission to give calcium, rather than bicarb. Delaying bicarb will not matter, while getting permission to give calcium will matter.

If the patient is stable, there is plenty of time for bicarb to work, but if the patient is stable the patient can probably also wait until after arrival at the hospital for treatment. If the patient is unstable and you only have bicarb in your protocol, do not delay at all on scene to give the bicarb, because the patient will be dead before sodium bicarbonate does anything. If the patient is unstable and you have calcium in your protocol, nothing works better or faster.

Patients with renal failure given the selective β2-adrenoceptor agonist, albuterol, by intravenous infusion (0.5 mg over 15 mins) show a significant decline in PK (about 1 mmol/L) that is maximal between 30 and 60 mins (47). Because injectable albuterol is unavailable in the United States, it is encouraging to note that nebulized albuterol in a high dose, administered to patients with end-stage renal disease, has a similar effect: PK declines by 0.6 mmol/L after inhalation of 10 mg of albuterol, and by about 1.0 mmol/L after 20 mg (41, 42, 48, 49).[2]

PK = Plasma concentration of Potassium (K). Added 7/12/2011 at 23:22

Go listen to the podcast.

To be continued in Part II.


[1] Bath Salt Abuse: EMS Garage Episode 140
EMS Garage
Page with links to download Podcast

[2] Management of severe hyperkalemia.
Weisberg LS.
Crit Care Med. 2008 Dec;36(12):3246-51. Review.
PMID: 18936701 [PubMed – indexed for MEDLINE]

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