An unusual way of acute Pyrazolam poisoning in consumer of commercially approved benzodiazepines.

PURPOSE: Designer benzodiazepines (D-BZDs) are a subclass of new psychoactive substances (NPS) posing heightened health risks. Pyrazolam, a triazolobenzodiazepine never marketed for medical use, remains poorly documented in clinical settings. The purpose of this study was to investigate an acute intoxication case to pyrazolam with quantification of this D-BZD in the different collected non biological and biological samples.

METHODS

Toxicological analyses were performed on plasma, urine, gastric aspirate, hair, and the ingested liquid using targeted and untargeted liquid chromatography–high-resolution mass spectrometry (LC-HRMS/MS), gas chromatography with flame ionization detection (GC-FID), and gas chromatography–mass spectrometry (GC-MS). The detectability of pyrazolam using routine immunoassays was also assessed.

RESULTS

The vodka solution contained ethanol (330 g/L) and pyrazolam (450 mg/L). Plasma pyrazolam concentration reached 500 ng/mL five hours post-ingestion and decreased to 270 ng/mL at 72 h. Pyrazolam, its glucuronide metabolite, and several co-ingested substances such as methylenedioxy-α-pyrrolidinohexaphenone, pentylone, methadone and commercial benzodiazepines were detected in the investigated matrices. Immunoassays allowed the detection of pyrazolam only in urine. Hair analysis supported the recent NPS use.

CONCLUSIONS

This case highlights the risk of severe intoxication with D-BZD and underscores the value of high-resolution mass spectrometry to identify emerging substances which may not be included in targeted approaches.