Evolution of the NBOMes: 25C- and 25B- Sold as 25I-NBOMe |
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Authors: | Larissa K Laskowski Faesal Elbakoush Jessica Calvo Gina Exantus-Bernard Jane Fong Justin L Poklis Alphonse Poklis Lewis S Nelson |
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Institution: | .New York University School of Medicine/New York City Poison Control Center, 455 First Avenue Room 123, New York, NY 10016 USA ;.Woodhull Medical Center, Brooklyn, NY USA ;.Bronx-Lebanon Hospital Center, New York, NY USA ;.Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA USA ;.Department of Pathology, Virginia Commonwealth University, Richmond, VA USA |
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Abstract: | IntroductionThe NBOMes (N-benzyl-oxy-methyl derivatives of known 2C phenylethylamines) are a new and growing class of potent synthetic stimulants. Case reports provide the bulk of available safety and clinical data for clinicians. We report two cases of NBOMe intoxication with 25C-NBOMe (the first lab-confirmed US case) and 25B-NBOMe, respectively, both confirmed via triple quadrapole mass spectrometry.Case ReportsCase 1: A 16-year-old girl had a generalized seizure after reported use of 25I-NBOMe. She presented with altered mental status, lower extremity rigidity, and elevated CPK (6042 U/L). Despite treatment with benzodiazepines, her lower extremity rigidity persisted and CPK peaked at 47,906 U/L. She was discharged on hospital day 8. Serum and urine specimens confirmed presence of 25C-NBOMe. Case 2: A 15-year-old boy developed bizarre behavior after reported use of 25I-NBOMe. In the ED, he had two generalized seizures and persistent muscle rigidity. CPK peaked at 429 U/L. Seizures were managed with benzodiazepines, and he was discharged within 24 h. Serum specimens revealed 25B-NBOMe.DiscussionNBOMes are amphetamine derivatives and highly potent 5-HT2A receptor agonists. Clinical manifestations are a product of enhanced central sympathetic and serotonergic tone. We report two cases of NBOMe intoxication in patients who believed they used 25I-NBOME, while lab confirmation proved otherwise. Whether unique clinical manifestations are specific to the NBOMe variant, dose, route of administration, or other factors is unknown. Laboratory confirmation may play a role in identifying unexpected NBOMe variants, while contributing to the epidemiologic data on these novel substances. |
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Keywords: | NBOMe Substituted phenylethylamines Serotonin toxicity New psychoactive substances Drugs of abuse |
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