We present a case report about an acute intoxication episode after an oral administration of Ayahuasca and dermal exposure of Kambo for treatment of depression. The clinical features observed were hallucination, agitation, tremors of extremities, oral paresthesia, skin lesions and seizures. Diazepam was administered by the emergency service and was effective in controlling hallucination, but failed to control agitation and seizures.
Patient biological fluids (urine and serum) and the samples of Ayahuasca and Kambo were submitted to toxicological analysis using liquid-liquid extraction followed by liquid chromatography–tandem mass spectrometry and high-resolution electrospray ionization-mass spectrometry.
The main active compounds present in Ayahuasca, N,N-dimethyltryptamine, harmine, harmaline and tetrahydroharmine were found and quantified in the different samples, confirming the use by the patient. In Kambo secretion used in the ritual, we were able to find sixteen potently active peptides: adenoregulin, bombesin, bombesinnona peptide, bradykinin -phe(8)-psi-CH2NH-arg(9)-, caerulein, deltorphin, neurokinin B, phyllomedusin, phyllocaerulein, phyllokinin, phyllolitorin, preprotachykinin B (50–79), ranatachykinin A, sauvagine, T-kinin and urechistachykinin II.
The patient was discharged the day after exposure without any sequel. Clinical and toxicological analysis indicated that the symptoms presented by the patient occurred due to a joint action produced by the substances identified in both materials. To the best of our knowledge, this is the first case involving probable intoxication by simultaneous administration of Ayahuasca and Kambo.
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The sample collection was approved by the “Sistema de Autorização e Informação em Biodiversidade” (Sisbio), process number 37974-1 and responsible professor Dr. Moisés Barbosa de Souza—Center of Biological and Nature Sciences/Federal University of Acre—UFAC, Rio Branco-Acre-Brazil.
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The authors thank all the institutions, Coordination for Improvement of Personnel with Higher Education—CAPES (Process Number 23038.006844/2014-46), The National Council for Scientific and Technological Development—CNPq (Process Number 830525/1999-8) and São Paulo Research Foundation—FAPESP (Process Number 2015/10650-8 and 2016/23157-0) for the fellowships and the financial support.
Conflict of interest
The authors declare no conflicts of interest.
The small amounts of blank human blood (to be prepared to serum) and urine samples were collected from healthy volunteers after obtaining the informed consent. This article does not contain any studies with animals performed by any of the authors.
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de Morais, D.R., Lanaro, R., Barbosa, I.L. et al. Ayahuasca and Kambo intoxication after alternative natural therapy for depression, confirmed by mass spectrometry. Forensic Toxicol 36, 212–221 (2018). https://doi.org/10.1007/s11419-017-0394-5
- Depression treatment
- High-resolution ESI-MS