Fatal Outcome Of Status Epilepticus, Hyperthermia, Rhabdomyolysis, Multi-Organ Failure, And Cerebral Edema After 25I-NBOMe Ingestion (P1.342)
Neurology April 8, 2014 Y. Umemura, T. Andrew, V. Jacobs et al.
A 17-year-old girl taking lithium and topiramate for mood disorders died after ingesting the designer drug 25I-NBOMe (street names "Smiles" and "N-Bomb") on blotter paper at a music concert. She presented with status epilepticus, then developed hyperthermia, metabolic acidosis, rhabdomyolysis, elevated transaminases, acute kidney injury, hypokalemia, and hypocalcemia. Irreversible cerebral edema led to brain death on hospital day 7. Antemortem whole blood testing confirmed 25I-NBOMe at concentrations above 0.25 ng/ml. The authors suggest death resulted from acute 25I-NBOMe ingestion combined with lithium, which has serotonergic effects, causing fatal serotonin syndrome, despite the lithium level being subtherapeutic at 0.34 mmol/L.