Journal of Intensive Care Medicine
May 28, 2012
Patil Armenian, Tanya M. Mamantov, Ben Tsutaoka et al.
81 citations
Twelve people who took MDMA at a single rave were hospitalized in the San Francisco Bay area with life-threatening complications including seizures and hyperthermia. Eight needed emergency breathing tubes, and six had dangerously low blood pressure. Most had high potassium levels, acute kidney injury, and muscle breakdown. Two died, four survived with permanent neurological, muscle, or kidney damage, and six recovered without lasting harm. Ten had hyperthermia, with seven reaching extreme temperatures between 40.9°C and 43°C. Cooling took an average of 2.7 hours. Drug analysis of two confiscated capsules showed they contained 82% and 98% pure MDMA, with one capsule holding 270 mg—more than twice a typical dose. The MDMA-induced hyperthermia, worsened by large doses, a warm environment, and physical exertion, was a major cause of death and injury.
The Journal of emergency medicine
October 1, 2019
James Grogan, Roy R Gerona, Jerry W Snow et al.
16 citations
Ibogaine, a psychoactive indole alkaloid used experimentally for opioid addiction and available via Internet suppliers, can cause life-threatening cardiac effects. A 34-year-old woman with heroin and cocaine use disorder ingested 2 g of ibogaine powder, experienced hallucinations and seizure-like episodes, and developed QTc prolongation and torsade de pointes. Qualitative analysis confirmed ibogaine in the ingested material. As more people with opioid use disorder seek ibogaine, emergency physicians need to recognize and treat this dangerous exposure.
The American journal of emergency medicine
July 1, 2015
Charles W O'Connell, Roy R Gerona, Matthew W Friesen et al.
16 citations
Ibogaine, a psychotropic indole alkaloid used in some medical subcultures for its anti-addictive properties, can cause serious health risks including altered mental status, ataxia, gastrointestinal distress, ventricular arrhythmias, and sudden death. A 33-year-old man overdosed on ibogaine while attempting to quit heroin, experiencing altered consciousness, tremor, ataxia, nausea, vomiting, and transient QT interval prolongation, which resolved as the substance cleared. Ibogaine was confirmed in his urine and serum, with a peak serum concentration of 377 ng/mL. Nonlinear elimination kinetics and the presence of its active metabolite noribogaine were also observed. This case provides serial serum concentrations and product-confirmed ibogaine toxicity with transient QT interval prolongation.
The American journal of emergency medicine
November 1, 2014
Patil Armenian, Roy R Gerona
15 citations
NBOMe derivatives, which are modified versions of the 2C class of phenethylamines, have recently appeared as designer drugs in the US market. While cases of toxicity from one derivative, 2C-I-NBOMe, have been documented, no reports have yet described the clinical effects of another derivative, 2C-C-NBOMe, leaving its toxicity profile unknown.
Pediatric Emergency Care
October 1, 2018
Stephen L Thornton, Sarah Hoehn, Roy R Gerona
6 citations
A 17-year-old male experienced seizures, systemic inflammatory response, and rhabdomyolysis after taking what he thought was LSD, but laboratory testing confirmed exposure to the designer drugs 4-iodo-2,5-dimethoxyphenethylamine (2C-I) and its n-benzyloxymethyl analog (25I-NBOMe). Seizures resolved with midazolam, but he required intubation. His urine drug screen was negative. Creatine kinase peaked at 14,579 U/L, and creatinine at 2.46 mg/dL. He recovered fully with intravenous fluids and was discharged after five days. The 2C drugs and their analogs are potent serotonergic agents associated with severe toxicity including seizures, rhabdomyolysis, and death, and should be considered in cases of drug-induced seizures.
The American journal of emergency medicine
February 1, 2025
Skyler Kessler, Bernard Weigel, Ross Ellison et al.
5 citations
A 61-year-old man with open skin ulcers from pyoderma gangrenosum developed ketamine toxicity after applying a large amount of a compounded analgesic cream containing 10% ketamine, 5% lidocaine, and 5% amitriptyline to his perineal and sacral region. He was brought to the emergency department with agitation, altered mental status, and torsional nystagmus after erratic driving. Urine testing showed a ketamine concentration of 32,300 ng/mL. His symptoms resolved spontaneously within a few hours. This case demonstrates that dermal application of ketamine cream can cause systemic toxicity when skin barrier function is impaired.
Clinical Toxicology
February 20, 2025
Courtney Temple, Matthew S. Correia, Ma Gonzaga et al.
3 citations
An analysis of psychoactive mushroom gummies found that their labeling was generally inaccurate. Products that suggested they contained Amanita muscaria instead contained serotonergic tryptamines, and some falsely claimed to be free of psilocybin.
Journal of Psychoactive Drugs
January 1, 2016
Michael A Darracq, Stephen L Thornton, Alicia B Minns et al.
2 citations
A 19-year-old woman had two seizures and dangerously low sodium after taking "ecstasy" at a rave. Laboratory analysis of her blood and urine showed she had taken both MDMA and 3,4-DMA, and that her body produced very low levels of MDMA's CYP2D6 metabolites, indicating impaired metabolism through that pathway. The case suggests that combining MDMA with 3,4-DMA can lead to severe toxicity, including hyponatremia and seizures. Healthcare providers should be aware that people using illicit drugs may take multiple substances, and that such combinations can cause serious harm.
Journal of Psychoactive Drugs
January 1, 2017
Stephen L Thornton, David Lisbon, Thomas Lin et al.
A 27-year-old man who snorted powder bought online had high blood pressure, rapid heart rate, dissociation, delayed speech, unsteady gait, and vertical nystagmus. Urine drug screening was positive for phencyclidine and a THC metabolite, but blood analysis detected methoxetamine and 3-methoxy-phencyclidine, not phencyclidine or THC. Methoxetamine concentrations were 279, 205, and 180 ng/mL; 3-methoxy-phencyclidine concentrations were 167, 131, and 90 ng/mL at 0, 2, and 3 hours after arrival. His mental state and blood pressure returned to normal eight hours later. This case adds to limited reports on these novel arylcyclohexylamines and their toxicity.