An unusual way of acute Pyrazolam poisoning in consumer of commercially approved benzodiazepines

PURPOSE: Designer benzodiazepines (D-BZDs) are a subclass of new psychoactive substances (NPS) posing heightened health risks. Pyrazolam, a triazolobenzodiazepine never marketed for medical use, remains poorly documented in clinical settings. The purpose of this study was to investigate an acute intoxication case to pyrazolam with quantification of this D-BZD in the different collected non biological and biological samples. METHODS: Toxicological analyses were performed on plasma, urine, gastric aspirate, hair, and the ingested liquid using targeted and untargeted liquid chromatography–high-resolution mass spectrometry (LC-HRMS/MS), gas chromatography with flame ionization detection (GC-FID), and gas chromatography–mass spectrometry (GC-MS). The detectability of pyrazolam using routine immunoassays was also assessed. RESULTS: The vodka solution contained ethanol (330 g/L) and pyrazolam (450 mg/L). Plasma pyrazolam concentration reached 500 ng/mL five hours post-ingestion and decreased to 270 ng/mL at 72 h. Pyrazolam, its glucuronide metabolite, and several co-ingested substances such as methylenedioxy-α-pyrrolidinohexaphenone, pentylone, methadone and commercial benzodiazepines were detected in the investigated matrices. Immunoassays allowed the detection of pyrazolam only in urine. Hair analysis supported the recent NPS use. CONCLUSIONS: This case highlights the risk of severe intoxication with D-BZD and underscores the value of high-resolution mass spectrometry to identify emerging substances which may not be included in targeted approaches.