Bath salts

Overview
The name bath salts is applied to a range of soluble, usually inorganic solid products designed to be added to a bath, either to improve cleaning, provide a medical improvement, to improve the experience of bathing, or to serve as a vehicle for cosmetic agents.

Such salts include:


 * magnesium sulfate (Epsom salts)
 * sodium chloride (table salt)
 * sodium bicarbonate (baking soda)
 * sodium hexametaphosphate (Calgon, amorphous/glassy sodium metaphosphate)
 * sodium sesquicarbonate
 * borax

Although many organic substances commonly used in or with bath water are salts (such as soap and many other surfactants), these are not usually called "bath salts". However, this does not rule out the possibility of low formula weight organic salts such as sodium citrate being called bath salts.

As with the naming of other additives, mixed preparations consisting largely though not entirely of salts as described herein may be called "bath salts". Commonest additions are fragrances and colors, and one purpose (in some products the most important one) of salts is as a vehicle or diluent to "stretch" fragrances, which are otherwise often too potent for convenient measurement or use. Other common additives to bath salts are oils (agglomerating the salts, the product being called "bath beads" or "bath oil beads"), foaming agents, and fizzing (effervescent) agents.

The appearance of the product before use is sometimes valued, and although bath salts are often packaged for retail in windowless boxes or bags, they may also be displayed in transparent containers. For instance, the needlelike appearance of sodium sesquicarbonate crystals makes them attractive for such purpose. However, bath salts may also be prepared as amorphous granules rather than crystals.

Effects of bath salts
Epsom salt is the most tested and has many effects on the muscles and nervous system.

Bath salts provide a variety of benefits to a bather. Salts change the osmotic balance of the water so that fewer salts are leeched from the skin via osmosis. This reduces the "pruning" or "wrinkling" effect of prolonged exposure of skin to fresh water. Magnesium sulphate has been shown to be absorbed through the skin, and magnesium has an anti-inflammatory effect.

Some bath salts such as phosphates have a detergent action which softens calloused skin and aids in exfoliation.

Some bath salts act as water softeners and change the way soap behaves and rinses.

High concentrations of salts increase the specific gravity of the water and increase buoyancy which makes the body feel lighter in the bath. Very high concentrations of salts in water are used in flotation therapy.

Bath salts are often used to mimic the properties of natural mineral baths or hot springs

Abuse
According to a recent study, Bath salts abuse is becoming common, and patients with PABS overdoses are presenting to emergency departments with increasing frequency. The primary ingredient of the synthetic designer drugs in these bath salts, which are not related to any hygiene product, is methylenedioxypyrovalerone (MDPV). MDPV is structurally related to pyrovalerone and α-pyrrolidinophenone compounds that inhibit norepinephrine–dopamine reuptake and thus act as central nervous system stimulants.

Effect
The sympathetic effects may include
 * tachycardia.
 * hypertension,
 * hyperthermia, and
 * seizures,
 * deaths have also been reported.

Altered mental status presents as
 * severe panic attacks,
 * agitation,
 * paranoia,
 * hallucinations, and
 * violent behavior (e.g., self-mutilation,
 * suicide attempts,
 * homicidal activity.

Thus Psychoactive Bath Salts (PABS) have been described as possessing the worst characteristics of
 * lysergic acid diethylamide (LSD),
 * phencyclidine (PCP, or angel dust),
 * methylenedioxymethamphetamine (ecstasy),
 * cocaine, and
 * methamphetamine.

Treatment
It is mainly supportive, typically with:
 * intravenous benzodiazepines (for sedation, to control seizures, or both) and
 * intravenous fluids, incase of suspicion of rhabdomyolysis.

Special Precautions
Physicians need to be aware of several issues, which are as follows
 * Intensive care unit care, because of the severity and potential lethality which can result from overdoses.
 * Specific drug screen, as routine drug screens do not detect PABS.
 * Differentiating PABS from other psychoactive substance abuse, which can confound the clinical presentation.
 * Need of physical restraints and high dose sedatives to prevent self harm and harm to others.