Severe clinical toxicity caused by 25I-NBOMe confirmed analytically using LC-MS-MS method

Area of Science:

• Toxicology
• Clinical Medicine
• Pharmacology

Background:

• Rhabdomyolysis is a critical condition involving muscle breakdown and the release of cellular contents into the bloodstream.
• Non-traumatic causes, particularly poisonings, are more common than traumatic origins of rhabdomyolysis.
• Elevated creatine kinase (CK) levels are a key indicator of muscle damage.

Observation:

• A patient developed extreme rhabdomyolysis following ingestion of a small dose of a novel psychoactive substance (NPS) identified as "Alice in Wonderland."
• The patient exhibited exceptionally high creatine kinase (CK) levels, reaching 516,455 U/l.
• This severe muscular injury occurred despite the relatively small dose of the ingested substance.

Findings:

• The case demonstrates a severe, non-traumatic rhabdomyolysis linked to a specific novel psychoactive substance.
• Laboratory analysis confirmed the presence of the substance using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method.
• The severity of the rhabdomyolysis was disproportionate to the ingested dose, suggesting high toxicity.

Implications:

• Novel psychoactive substances pose significant health risks, including severe rhabdomyolysis, even at low doses.
• This case underscores the importance of prompt identification and diagnosis of NPS-induced toxicity.
• Advanced analytical techniques like LC-MS/MS are crucial for detecting and quantifying these substances in clinical toxicology settings.