Sunday, October 25, 2015

Severe Toxicity after Synthetic Cannabinoid Exposure in an Infant (NACCT 2015)

This case report from Hawkins et al. and the Louisiana Poison Center and Louisiana State University Health Sciences Center in Shreveport, LA was published in Clinical Toxicology as an abstract presented at the 2015 Annual Meeting of the North American Congress of Clinical Toxicology (NACCT), 53:7, 639-777.

Severe Toxicity after Synthetic Cannabinoid Exposure in an Infant
J.A. Hawkins, M.L. Ryan, T.C. Arnold

In summary:

A 10 month old child presented to a Louisiana emergency department after ingesting herbal potpourri. The child had consumed the potpourri several hours prior to arrival and was suffering from altered mental status including unresponsiveness, moaning, and rigidity.

At presentation, the child’s blood pressure was 108/71 mm Hg, pulse was 71 beats per minute (bradycardia), respiration was 22 breaths per minute, and rectal temperature was 90.4 F (hypothermia). Glucose was 162 mg/dL. Blood urea nitrogen was 32 mg/dL. Lactic acid in serum was 3.6 mmol/L.

The child was intubated on admission due to prolonged apnea/oxygen desaturation and extubated on hospital day two. He recovered fully and was discharged on the third day and allowed to return home.

Analysis of the product consumed by the child was positive for the synthetic cannabinoid MAB-CHMINACA. Toxicological analysis on the admission serum specimen was positive for the presence of MAB-CHMINACA and a metabolite of said compound.

I have covered a bit about MAB-CHMINACA here at TDMTP over the last year or so.

Thursday, October 15, 2015

New Reports of Synthetic Cannabinoid Deaths (TIAFT 2015)

The International Association of Forensic Toxicologists (TIAFT) held their annual meeting in Florence, Italy during September 2015.

There were three presentations in which synthetic cannabinoid-related deaths were reported. The synthetic cannabinoids involved included MMB-CHMINACA, PB-22, and 5F-PB-22.

MMB-CHMINACA Blood Concentrations in Recreational Users and Fatal Intoxications
R. Kronstrand, E. Tyrkko*, D. Lindstedt, M. Roman

Tyrkko et al. report that during 2014 in Sweden, the synthetic cannabinoid MMB-CHMINACA was detected in six postmortem cases. Two of the six cases were certified as fatal intoxications with MMB-CHMINACA with blood concentrations equal to 0.001 and 0.003 mcg/g. In both cases, autopsy findings were unremarkable.

Three Deaths Involving Synthetic Cannabinoid PB-22
M.G. Pricone*, S. Yap, D. Gerostamoulos, O.H. Drummer, N.W. Woodford

Pricone et al. report that in Australia in 2014 during a four month period three deaths occurred where the synthetic cannabinoid PB-22 was identified as the main toxicological finding. Individuals were 19, 23, and 33 years of age. The blood concentrations of PB-22 were 0.2, 0.5, and 3 ng/mL.  Causes of death in two of the cases were certified as PB-22 associated. The cause of death in one of the cases remains undetermined.

Death After Consumption of New Synthetic Cannabinoids and Alcohol
A. Ewald*, N. Schaefer, B. Peters, P. Schmidt

Ewald et al. reported a case out of Germany of a 33 year old male who was found deceased in his friend’s house.  He had last  been seen alive by a friend a few hours prior to being discovered. The deceased individual had a history of ethanol and synthetic cannabinoid consumption. Findings at autopsy included visceral edema/congestion and a respiratory tract infection. Toxicological findings of peripheral blood were 5F-PB-22 (0.85 ng/mL) and ethanol (0.265%). Cause of death was determined to be combined intoxication of PB-22 and ethanol.

* It is important to note that MMB-CHMINACA was the first purported name of the compound as it was sold as such by chemical vendors. But, the actual compound is not an indazole carboxamide, it is an indole carboxamide and a more suitable name is MDMB-CHMICA. Just more alphabet soup synthetic cannabinoids! Also just lends credence to the line of thinking that you cannot (or should not) completely trust research chemical vendors. According to Shevyrin et al., true MMB-CHMINACA had not been found on the market as of January 2015.