A 37-year-old man with a history of drug abuse was found unconscious with bags of powder labeled as research chemicals and traces of powder on his nose. He was rehydrated, intubated, and admitted to the intensive care unit. Urine analysis identified several new psychoactive substances, including high concentrations of 3-OH-PCP (12,085 mg/L) and 3-MeO-PCP (1,100 mg/L), along with 2F-DCK, N-ethylhexedrone, and CMC. Molecular networking, a bioinformatic approach, confirmed that the powders in the bags matched the substances found in the patient's urine. This case demonstrates how molecular networking can aid in sample comparison, target quantification methods, and support treatment decisions for intoxications involving arylcyclohexylamine compounds.
A 26-year-old man with no psychiatric history and no suicidal symptoms was found dead in a locked house with large neck wounds. A dropper bottle containing LSD was near the body, and toxicology confirmed acute LSD exposure: LSD at 1460 pg/mL and O-H-LSD at 182 pg/mL in blood, with LSD, nor-LSD, and O-H-LSD in urine at 3670, 201, and 4890 ng/L. This is the first reported case of fatal self-inflicted neck wounds during acute LSD intoxication in a person without prior mental illness. The case is notable given renewed interest in LSD therapy, though the literature has not shown a link between LSD exposure and suicide risk.
A 20-year-old man arrived at an emergency department in a state of euphoria, disorientation, intense visual hallucinations, episodic amnesia, and agitation requiring physical restraint after consuming an unusual form of hallucinogenic mushroom. The patient's family brought intact specimens, but no health professional could identify them. Toxicological screening detected psilocin in both the patient's urine and the mushrooms, guiding identification toward the Psilocybes genus. Ten hours after ingestion, the patient was discharged asymptomatic. Recognizing unusual forms of hallucinogenic mushrooms may help emergency physicians improve diagnosis and management, especially since hallucinogenic substances are not routinely tested in toxicological analyses.