Thornton Stephen L, Hoehn Sarah, Gerona Roy R
Department of Pediatrics, University of Kansas Medical School, Kansas City, KS.
Department of Laboratory Medicine, University of California-San Francisco, San Francisco General Hospital, San Francisco, CA.
Pediatr Emerg Care. 2018 Oct;34(10):e181-e183. doi: 10.1097/PEC.0000000000001117.
The 2C drugs are hallucinogenic phenethylamines. They and their n-benzyloxymethyl analogs have become popular as "legal highs," and significant toxicity has been attributed to their use. We report on a case of seizures, systemic inflammatory response, and rhabdomyolysis associated with laboratory-confirmed 4-iodo-2,5-dimethoxyphenethylamine and 4-iodo-2,5-dimethoxy-N-(2-methoxybenzyl) phenethylamine exposure. A 17-year-old male teenager developed seizures after taking "2 strips of acid." The seizures resolved with midazolam, but he became apneic and was intubated. His head computed tomography was unremarkable. Initial creatinine level was 1.5 mg/dL, with a creatine kinase of 112 U/L. His urine immunoassay drug screen was negative. He was extubated within 12 hours but had elevated temperatures for 48 hours. He was treated with antibiotics, but no source of infection was identified. His creatinine level peaked at 2.46 mg/dL. His creatine kinase peaked 72 hours later at 14579 U/L. He was treated with intravenous fluids and did not require renal replacement therapy. He recovered fully and was discharged after 5 days. Serum and urine samples were tested using liquid chromatography time-of-flight mass spectrometry. We detected 4-iodo-2,5-dimethoxyphenethylamine and 4-iodo-2,5-dimethoxy-N-(2-methoxybenzyl) phenethylamine in both serum and urine. No other substances were detected. The 2C drugs and their n-benzyloxymethyl analogs are potent serotonergic agents. Their use has been associated with multiple adverse effects including seizures, rhabdomyolysis, and death. They should be considered in differential diagnosis for drug-induced seizures and as a cause for systemic inflammatory response. This case highlights the significant toxicity seen with these compounds.
2C类药物是致幻苯乙胺。它们及其N-苄氧基甲基类似物作为“合法兴奋剂”已变得流行起来，并且其使用已被认为具有显著毒性。我们报告一例与实验室确诊的4-碘-2,5-二甲氧基苯乙胺和4-碘-2,5-二甲氧基-N-(2-甲氧基苄基)苯乙胺暴露相关的癫痫发作、全身炎症反应和横纹肌溶解病例。一名17岁男性青少年在服用“两条迷幻药”后出现癫痫发作。癫痫发作通过咪达唑仑得到缓解，但他出现呼吸暂停并接受了插管。他的头部计算机断层扫描无异常。初始肌酐水平为1.5mg/dL，肌酸激酶为112U/L。他的尿液免疫分析药物筛查为阴性。他在12小时内拔管，但体温升高了48小时。他接受了抗生素治疗，但未发现感染源。他的肌酐水平峰值为2.46mg/dL。他的肌酸激酶在72小时后达到峰值，为14579U/L。他接受了静脉输液治疗，不需要肾脏替代治疗。他完全康复并在5天后出院。血清和尿液样本采用液相色谱飞行时间质谱法进行检测。我们在血清和尿液中均检测到了4-碘-2,5-二甲氧基苯乙胺和4-碘-2,5-二甲氧基-N-(2-甲氧基苄基)苯乙胺。未检测到其他物质。2C类药物及其N-苄氧基甲基类似物是强效血清素能药物。它们的使用与多种不良反应有关，包括癫痫发作、横纹肌溶解和死亡。在药物性癫痫发作的鉴别诊断中应考虑到它们，并将其作为全身炎症反应的一个原因。本病例突出了这些化合物所见的显著毒性。
