title: Spice/K2 synthetic marijuana-induced toxic hepatitis treated with N-acetylcysteine.
abstract: BACKGROUND
  Spice/K2 is one of several street names for synthetic marijuana. These hallucinogens are increasingly sold over the internet and in "head" shops. They are usually household herbs that are sprayed with chemicals that become centrally active compounds when burned together and inhaled by smoking.
  
  
  METHODS
  We present a case of a 45-year-old male substance abuser who was admitted with evidence of hepatocellular necrosis and worsening liver failure. Tests for acetaminophen were negative, as were tests for alcohol. The patient was empirically treated with N-acetylcysteine. Hepatocellular damage was abated and the patient made a full recovery. Upon regaining consciousness, the patient admitted to smoking Spice/K2. Other toxicities have been reported with synthetic marijuana use, but not liver toxicity.
  
  
  CONCLUSIONS
  Physicians need to have a high index of suspicion for unknown hepatotoxins in substance abusers. N-acetylcysteine can be given if there is no contraindication.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Columbia University, Harlem Hospital Center, New York, USA.
authors.forename: Israr A
authors.initials: IA
authors.lastname: Sheikh
authors.affiliation: Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Miha
authors.initials: M
authors.lastname: Lukšič
authors.affiliation: Division of Gastroenterology, Department of Medicine, Columbia University, Harlem Hospital Center, New York, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Ferstenberg
authors.affiliation: Division of Gastroenterology, Department of Medicine, Columbia University, Harlem Hospital Center, New York, USA.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Culpepper-Morgan
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D002186:Cannabinoids / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017365:Spices / Q000009:adverse effects
chemical_list: D000998:Antiviral Agents; D002186:Cannabinoids; D013287:Illicit Drugs; D000111:Acetylcysteine