Severe clinical toxicity caused by 25I-NBOMe confirmed analytically using LC-MS-MS method
Rhabdomyolysis is a relatively rare, but potentially serious
complication of various diseases. Muscular injury
and resultant release of electrolytes, myoglobin and
other enzymatic proteins e.g. creatine kinase (CK) into
circulation may result in multi-organ failure requiring an
extensive treatment. Non-traumatic causes of rhabdomyolysis,
like poisonings, appear to be much more frequent
than traumatic causes. We present the case of a patient
who developed exceptionally massive rhabdomyolysis,
with CK up to 516 455 U/l, after ingestion of a relatively
small dose of a novel psychoactive substance known
as “Alice in Wonderland”. Laboratory quantification was
performed using a validated LC-MS/MS method in a
whole blood sample.
Adamowicz P, Tokarczyk B (2016) Simple and rapid screening procedure for 143 new psychoactive substances by liquid chromatography-tandem mass spectrometry. Drug Test. Analysis 8:652-67. https://doi.org/10.1002/dta.1815
Altintepe L, Guney I, Tonbul Z, Turk S, Mazi M, Agca E, Yeksan M (2007) Early and intensive fluid replacement prevents acute renal failure in the crush cases associated with spontaneous collapse of an apartment in Konya. Ren Fail 29:737-41. https://doi.org/10.1080/08860220701460095
Better OS, Rubinstein I (1997) Management of shock and acute renal failure in casualties suffering from the crush syndrome. Ren Fail 19:647-53. https://doi.org/10.1038/ki.1997.409
Bosch X, Poch E, Grau JM (2009) Rhabdomyolysis and acute kidney injury. N Engl J Med 361:62-72. https://doi.org/ 10.1056/NEJMra0801327
Cervellin G, Comelli I, Lippi G (2010) Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features. Clin Chem Lab Med 48:749-56. https://doi.org/10.1515/CCLM.2010.151
Efstratiadis G, Voulgaridou A, Nikiforou D, Kyventidis A, Kourkouni E, Vergoulas G (2007) Rhabdomyolysis updated. Hippokratia 11:129-37.
Hill SL, Doris T, Gurung S, Katebe S, Lomas A, Dunn M, Blain P, Thomas SH (2013) Severe clinical toxicity associated with analytically confirmed recreational use of 25I-NBOMe: case series. Clin Toxicol 51: 487-492. https://doi.org/10.3109/15563650.2013.802795
Huerta-Alardin AL, Varon J, Marik PE (2005) Bench-to-bedside review: Rhabdomyolysis - an overview for clinicians. Crit Care 9:158-69. https://doi.org/ 10.1186/cc2978
Joannidis M, Druml W, Forni LG, Groeneveld AB, Honore P, Oudemans-van Straaten HM, et al. (2010) Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology, ESICM. Intensive Care Med 36:392-411. https://doi.org/ 10.1007/s00134-009-1678-y.
Johnson RD, Botch-Jones SR, Flowers T, Lewis CA (2014) An evaluation of 25B-, 25C-, 25D-, 25H-, 25I- and 25T2-NBOMe via LC-MS-MS: method validation and analyte stability. J Anal Toxicol 38:479-84. https//doi.org/10.1093/jat/bku085.
Keltz E, Khan FY, Mann G (2013) Rhabdomyolysis. The role of diagnostic and prognostic factors. Muscles Ligaments Tendons J 3:303-12.
Melli G, Chaudhry V, Cornblath DR (2005) Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine 84:377-85. https://doi.org/10.1097/01.md.0000188565.48918.41
Poklis JL, Devers KG, Arbefeville EF, Pearson JM, Houston E, Poklis A (2014) Postmortem detection of 25I-NBOMe [2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine] in fluids and tissues determined by high performance liquid chromatography with tandem mass spectrometry from a traumatic death. Forensic Sci Int 234: e14–e20. https://doi.org/10.1016/j.forsciint.2013.10.015
Rose SR, Cumpston KL, Stromberg PE, Wills BK (2012) Severe poisoning following self-reported use of 25-I, a novel substituted amphetamine. Clin. Toxicol 50: 707-708.
Rose SR, Poklis JL, Poklis A (2013) A case of 25I-NBOMe (25-I) intoxication; a new potent 5HT2a agonist designer drug. Clin. Toxicol 51: 174-177. https://doi.org/10.3109/15563650.2013.772191
Russell TA (2005) Acute renal failure related to rhabdomyolysis: pathophysiology, diagnosis, and collaborative management. Nephrol Nurs J 32:409-17.
Scientific Working Group for Forensic Toxicology (SWGTOX) (2013) Standard Practices for Method Validation in Forensic Toxicology. J. Anal Toxicol 37: 452-474. https://doi.org/ 10.1093/jat/bkt054.
Shanks KG, Sozio T, Behonick GB (2015) Fatal Intoxications with 25B-NBOMe and 25I-NBOMe in Indiana During 2014. J Anal Toxicol 39:602-606. https//doi.org/10.1093/jat/bkv058.
Sharon GC (2005) Rhabdomyolysis. Orthop Nurs 24:443-7.
Takizawa D, Nishikawa K, Hiraoka H, Hinohara H, Saito S, Goto F, Kunimoto F (2004) Successful management of a patient with neuroleptic malignant syndrome associated with marked elevation of serum creatine kinase. J Anesth 18:135-7. https://doi.org/10.1007/s00540-003-0223-3
Weaver MF, Hopper JA, Gunderson E W (2015) Designer drugs 2015: assessment and management. Addict Sci Clin Pract 10(1): 8. https://doi.org/10.1186/s13722-015-0024-7.
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