title: Severe clinical toxicity associated with analytically confirmed recreational use of 25I-NBOMe: case series.
abstract: BACKGROUND
  4-Iodo-2,5-dimethoxy-N-(2-methoxybenzyl)phenethylamine (25I-NBOMe) is a N-methoxybenzyl-substituted phenethylamine with potent serotoninergic effects. We describe seven cases of analytically confirmed toxicity due to the recreational use of 25I-NBOMe in the United Kingdom.
  
  
  METHODS
  Seven patients, all young adult males, presented to hospitals in the northeast of England with clinical toxicity after recreational drug use in January 2013. Clinical features included tachycardia (n = 7), hypertension (4), agitation (6), aggression, visual and auditory hallucinations (6), seizures (3), hyperpyrexia (3), clonus (2), elevated white cell count (2), elevated creatine kinase (7), metabolic acidosis (3), and acute kidney injury (1). LC-MS/MS analysis identified 25I-NBOMe as the main active substance in the plasma of all seven cases.
  
  
  CONCLUSIONS
  Severe clinical toxicity may occur following recreational use of 25I-NBOMe, with stimulant and serotoninergic features predominating. Clinicians should be alert to this substance, in view of its emergence in Europe as well as in the United States.
authors.affiliation: Medical Toxicology Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK. simon.hill@ncl.ac.uk
authors.forename: Simon L
authors.initials: SL
authors.lastname: Hill
authors.forename: Tom
authors.initials: T
authors.lastname: Doris
authors.forename: Shiv
authors.initials: S
authors.lastname: Gurung
authors.forename: Stephen
authors.initials: S
authors.lastname: Katebe
authors.forename: Alexander
authors.initials: A
authors.lastname: Lomas
authors.forename: Mick
authors.initials: M
authors.lastname: Dunn
authors.forename: Peter
authors.initials: P
authors.lastname: Blain
authors.forename: Simon H L
authors.initials: SH
authors.lastname: Thomas
mesh_terms: D000328:Adult; D017109:Akathisia, Drug-Induced / Q000209:etiology; D001596:Benzylamines / Q000097:blood / Q000633:toxicity*; D004118:Dimethoxyphenylethylamine / Q000031:analogs & derivatives; D004739:England / Q000453:epidemiology; D008401:Gas Chromatography-Mass Spectrometry; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D013287:Illicit Drugs / Q000097:blood / Q000633:toxicity*; D008297:Male; D010627:Phenethylamines / Q000097:blood / Q000633:toxicity*; D019966:Substance-Related Disorders / Q000453:epidemiology; D013610:Tachycardia / Q000139:chemically induced; D055815:Young Adult
chemical_list: D001596:Benzylamines; D004118:Dimethoxyphenylethylamine; D013287:Illicit Drugs; D010627:Phenethylamines; C554181:2-(4-iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine