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Evolution of the NBOMes: 25C- and 25B- Sold as 25I-NBOMe

  • Toxicology Observation
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Abstract

Introduction

The NBOMes (N-benzyl-oxy-methyl derivatives of known 2C phenylethylamines) are a new and growing class of potent synthetic stimulants. Case reports provide the bulk of available safety and clinical data for clinicians. We report two cases of NBOMe intoxication with 25C-NBOMe (the first lab-confirmed US case) and 25B-NBOMe, respectively, both confirmed via triple quadrapole mass spectrometry.

Case Reports

Case 1: A 16-year-old girl had a generalized seizure after reported use of 25I-NBOMe. She presented with altered mental status, lower extremity rigidity, and elevated CPK (6042 U/L). Despite treatment with benzodiazepines, her lower extremity rigidity persisted and CPK peaked at 47,906 U/L. She was discharged on hospital day 8. Serum and urine specimens confirmed presence of 25C-NBOMe. Case 2: A 15-year-old boy developed bizarre behavior after reported use of 25I-NBOMe. In the ED, he had two generalized seizures and persistent muscle rigidity. CPK peaked at 429 U/L. Seizures were managed with benzodiazepines, and he was discharged within 24 h. Serum specimens revealed 25B-NBOMe.

Discussion

NBOMes are amphetamine derivatives and highly potent 5-HT2A receptor agonists. Clinical manifestations are a product of enhanced central sympathetic and serotonergic tone. We report two cases of NBOMe intoxication in patients who believed they used 25I-NBOME, while lab confirmation proved otherwise. Whether unique clinical manifestations are specific to the NBOMe variant, dose, route of administration, or other factors is unknown. Laboratory confirmation may play a role in identifying unexpected NBOMe variants, while contributing to the epidemiologic data on these novel substances.

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Sources of Funding

Laboratory analysis was supported in part by the National Institutes of Health (NIH) Center grant P30DA033934.

Conflict of Interest

The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

Previous Presentation of Data

Laskowski LK, Calvo J, Exantus-Bernard G, Fong J, Poklis JL, Poklis A, Nelson L. NBOMes Lost in Translation: What You See is Not What You Get [abstract.] NACCT 2014.

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Authors and Affiliations

  1. New York University School of Medicine/New York City Poison Control Center, 455 First Avenue Room 123, New York, NY, 10016, USA

    Larissa K. Laskowski & Lewis S. Nelson

  2. Woodhull Medical Center, Brooklyn, NY, USA

    Faesal Elbakoush

  3. Bronx-Lebanon Hospital Center, New York, NY, USA

    Jessica Calvo, Gina Exantus-Bernard & Jane Fong

  4. Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, USA

    Justin L. Poklis & Alphonse Poklis

  5. Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA

    Alphonse Poklis

Authors
  1. Larissa K. Laskowski
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  2. Faesal Elbakoush
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  3. Jessica Calvo
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  4. Gina Exantus-Bernard
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  5. Jane Fong
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  6. Justin L. Poklis
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  7. Alphonse Poklis
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  8. Lewis S. Nelson
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Correspondence to Larissa K. Laskowski.

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Laskowski, L.K., Elbakoush, F., Calvo, J. et al. Evolution of the NBOMes: 25C- and 25B- Sold as 25I-NBOMe. J. Med. Toxicol. 11, 237–241 (2015). https://doi.org/10.1007/s13181-014-0445-9

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  • DOI: https://doi.org/10.1007/s13181-014-0445-9

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