Acute Toxicity Associated with Use of 5F-Derivations of Synthetic Cannabinoid Receptor Agonists with Analytical Confirmation

INTRODUCTION

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.

CASE REPORT

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.

DISCUSSION

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.

High-dose montelukast exposures in a 3-year-old and a 5-year-old child

The leukotriene receptor antagonists (LTRAs) is a relatively new class of asthma medication with a lack of toxicity for unintentional poisoningsituations. This makes it difficult to determine which exposures require aggressive decontamination or simple monitoring in the home setting: prompting the question, "What LTRA dose is likely to produce significant toxicity?" We report a case of an unintentional poisoning with 80 mg montelukast in a 3-y-o asthmatic child that was managed in the home with observation alone and a second case of untentional 135 mg montelukast poisoning in a 5-y-o asthmatic child managed in an emergency department. In both cases, symptoms were not observed. These cases and available literature suggest that doses < 4.5 mg/kg in children result in minimal toxicity.

Death in sheep following dosing with copper diethylamine oxyquinoline sulphonate as a commercial injectable copper preparation

Death occurred in sheep following diethylamine oxyquinoline sulphonate (DOS) copper injections given at recommended dose rates. The copper content in unused portions of DOS copper packs was normal and free of bacterial contamination. Liver and blood copper levels in dead and sick sheep were not high. Sick sheep showed signs of hepatic encephalopathy and dead sheep were generally piled against fences and scrub. Deaths were associated with acute, severe, generalised, centrilobular, hepatocellular necrosis and live sheep had elevated circulating levels of liver enzymes consistent with liver damage. In recovered sheep there were no residual complications. It would appear that even at 0.5 mg/kg of DOS copper the safety threshold may sometimes be exceeded in some sheep.

Toxicity of halogenated oxyquinolines in dogs. A clinical study. V. Pathological findings

A description is given of the post-mortem findings in 21 cases of acute spontaneous oxyquinoline poisoning in dogs after administration of halogenated oxyquinoline drugs once or over a short period. The findings are in accordance with the results of necropsy of 7 cases of experimentally induced oxyquinoline poisoning. Biopsy specimens of the liver were taken in 18 dogs. The investigation reveals that spontaneous as well as experimental poisonings give rise to severe myocardial and liver injuries. The myocardial lesions consisted of focal necrosis with interstitial cellular reaction. The areas of necrosis were most frequent in the papillary muscles of the left ventricle. The liver-cell damage ranged from cloudy swelling to hydropic degeneration with depositions of lipids. In 3 experimental cases, in which rapid fixation methods were used, it was possible to evaluate the pathological lesions in the neurons of the brain and spinal cord. Degenerative neuronal changes with chromatolysis and vacuolation were observed, especially in the hippocampus and hypothalamus. It was presumed that the injuries and destruction of these structures had caused symptoms that were consistent with the clinical pictures of the dogs. The clinical symptoms and post-mortem changes were believed to be due to a toxic effect on the myocardium, liver, and central nervous system.

Toxicity of halogenated oxyquinolines in dogs. A clinical study. I. A survey of cases

A survey of 100 cases of oxyquinoline poisoning in dogs is presented. The disease, characterized by hyperexcitability of the CNS with convulsions as well as heart and liver injury, runs an acute course. The mortality (euthanized dogs included) was 30 %. Case-history data showed that the oxyquinoline treatment which preceded the disease was given because the dog had incidental diarrhoea. In most cases the drugs were administered for only 1 day before the dog fell ill. The median time from the last dose to onset of symptoms was 12 hrs. Old dogs were affected more often than expected and also showed higher mortality than did young dogs.

A comparison of serum creatine phosphokinase and serum glutamic oxalacetic transaminase in skeletal muscle necrosis

Rabbits were poisoned by the intraperitoneal injection of plasmocid dihydroiodide at a dosage of 80 mg. per kg. body weight. Animals were euthanatized 1, 2, 5, 7, 9, 12, 24 and 48 hours after plasmocid injection and serum and diaphragmatic muscle collected. The serum was examined for its serum glutamic oxalacetic transaminase (SGOT) and creatine phosphokinase (CPK) concentrations. The diaphragm was sectioned and examined for the progression of morphologic alterations. It was found that SGOT and CPK concentrations were similar in their time and duration of elevation and that the serum CPK elevations closely paralleled the occurrence and degree of morphologic muscle degeneration. It appears that CPK is the most specific clinical biochemical test for the detection of muscle necrosis available at this time.