title: Acute Toxicity Associated with Use of 5F-Derivations of Synthetic Cannabinoid Receptor Agonists with Analytical Confirmation.
abstract: Synthetic Cannabinoid Receptor Agonists (SCRAs) are the largest group of new psychoactive substances reported to the European Warning System and the United Nations Office on Drugs and Crime to date. The heterogeneous nature and speed of diversification of these compounds make it challenging to accurately characterise and predict harms of these compounds in pre-clinical studies, ahead of their appearance.
  
  
  
  We report the case of a 19-year-old female who purchased three products from a headshop: two new psychoactive substances (sachets of "cannabis tea" and "mushroom tea") as well as two LSD blotters. After the "cannabis tea" was smoked and the two LSD blotters and "mushroom tea" were ingested, the patient became tachycardic (HR 128), developed seizures, agitation, visual hallucinations as well as suspected serotonergic toxicity (sustained ankle clonus 20-30 beats) 1-2 hours after use. She was treated with 1 mg of intravenous midazolam. Symptoms/signs resolved within 13 hours. No further supportive care was required. Plasma, blood, and urine samples confirmed the presence of two SCRAs: 5FAKB-48 and 5F-PB-22. The patient also reported therapeutic use of both fluoxetine and citalopram for depression.
  
  
  
  To the best of our knowledge, this is the first case report of non-fatal intoxication with 5F-AKB-48 with analytical confirmation and exposure times. It also highlights the difficulties in understanding the pattern of toxicity of certain SCRAs in the context of psychotropic medications/co-morbid mental illness.
authors.affiliation: Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. rachelle.abouchedid@gstt.nhs.uk.|Emergency Department, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. rachelle.abouchedid@gstt.nhs.uk.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Abouchedid
authors.affiliation: Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.|Emergency Department, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
authors.forename: James H
authors.initials: JH
authors.lastname: Ho
authors.affiliation: LGC Ltd, Fordham, Cambridgeshire, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Hudson
authors.affiliation: Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Dines
authors.affiliation: Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.|Faculty of Life Sciences and Medicine, King's College London, London, UK.
authors.forename: John R H
authors.initials: JR
authors.lastname: Archer
authors.affiliation: Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.|Faculty of Life Sciences and Medicine, King's College London, London, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
authors.affiliation: Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.|Faculty of Life Sciences and Medicine, King's College London, London, UK.
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
mesh_terms: D000218:Adamantane / Q000031:analogs & derivatives* / Q000097:blood / Q000506:poisoning / Q000652:urine; D061605:Administration, Intravenous; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D063386:Cannabinoid Receptor Agonists / Q000097:blood / Q000506:poisoning*; D015283:Citalopram / Q000627:therapeutic use; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D006212:Hallucinations / Q000139:chemically induced / Q000188:drug therapy; D006213:Hallucinogens / Q000009:adverse effects / Q000633:toxicity; D006801:Humans; D007191:Indazoles / Q000097:blood / Q000506:poisoning* / Q000652:urine; D007211:Indoles / Q000097:blood / Q000506:poisoning* / Q000652:urine; D008238:Lysergic Acid Diethylamide / Q000009:adverse effects / Q000633:toxicity; D008874:Midazolam / Q000627:therapeutic use; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000209:etiology; D011804:Quinolines / Q000097:blood / Q000506:poisoning* / Q000652:urine; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D013610:Tachycardia / Q000188:drug therapy / Q000209:etiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D063386:Cannabinoid Receptor Agonists; D006213:Hallucinogens; D007191:Indazoles; D007211:Indoles; D011804:Quinolines; D005473:Fluoxetine; D015283:Citalopram; D008238:Lysergic Acid Diethylamide; D000218:Adamantane; C000620621:1-pentyfluoro-1H-indole-3-carboxylic acid 8-quinolinyl ester; D008874:Midazolam; C000603150:N-(1-adamantyl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide
keywords: 5F-AKB-48; 5F-PB-22; Novel psychoactive substances; Recreational drug toxicity; Synthetic cannabinoid receptor agonist