Ingestion of Synthetic Street Drug “25-I” (25I-NBOMe) Causing Type B Lactic Acidosis and Multi-Organ Dysfunction

Matthew L. Friedman, Marcelo Malakooti, Craig Smith, Zena Leah Harris, Mark Wainwright

Abstract


25I-NBOMe (25-I) is a novel synthetic agonist of the 5-HT2A receptor. It is used recreationally for its psychedelic properties similar to LSD. Side effects include altered mental status, sympathomimetic symptoms, serotonin syndrome and multiple organ injury. We report a case of delayed type B lactic acidosis after ingestion of 25-I. A 16-year-old male presented after being found obtunded. He developed seizures requiring endotracheal intubation. He developed a lactic acidosis about 30 hours after ingestion, peaking at 8.5 mEq/L 38 hours post-ingestion. Concurrently the patient had an elevated mixed venous saturation and decreased arterial-venous oxygen content difference, indicating a type B lactic acidosis. Thiamine, L-carnitine, and coenzyme Q-10 were initiated to treat the metabolic derangement and promote oxygen utilization. Additional treatments included n-acetylcysteine and plasmapheresis. This treatment strategy resulted in reduction in lactate and other markers of organ injury. Arterial-venous oxygen content difference increased to normal levels. The patient made a full recovery. Type B lactic acidosis has been reported previously in a variety of diseases, but never after 25-I ingestion. A novel approach of vitamins and co-factors to support mitochondrial function, n-acetylcysteine and plasmapheresis was employed to treat the lactic acidosis and multi-organ dysfunction successfully.




J Med Cases. 2015;6(3):125-127
doi: http://dx.doi.org/10.14740/jmc2023w

Keywords


Mitochondrial dysfunction; Thiamine; Carnitine; Plasmapheresis; Type B lactic acidosis; 25-I

Full Text: HTML PDF
 

Browse  Journals  

     

Journal of clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.            
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.