Journal of forensic and legal medicine · 2021
Severe poisoning after smoking a mixture of 4-fluoroisobutyryl fentanyl (4-FiBF) and alpha-pyrolidinoisohexaphenone (α-PiHP).
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Zawadzki Marcin, Wachełko Olga, Tusiewicz Kaja, Szpot Paweł
Аннотация
CONTEXT: Intoxications after ingestion of new psychoactive substances are currently one of the most challenging issues in clinical toxicology. Synthetic cathinones represented the largest group of drugs seized in 2020, but the increasing distribution of fentanyl analogues is resulting in a growing global opioid crisis. In addition, synthetic opioids may be intentionally combined with psychostimulants by drug manufacturers to reduce depressive effects. We report a case of severe poisoning after smoking a mixture of 4-fluoroisobutyryl fentanyl (4-FiBF) and alpha-pyrrolidinoisohexaphenone (α-PiHP).
CASE DETAILS: A 29-year-old male was found out of conscious in his apartment and taken to the Intensive Care Unit. Examinations revealed pinpoint pupils, slight respiratory acidosis, leukocytosis as well as body temperature of 39.4 °C and increased creatinine with decreased eGFR level. Toxicological analysis of biological samples revealed presence of 4-FiBF and α-PiHP in concentrations: 87.7 ng/mL and 5.0 ng/mL (blood) and 2291.0 ng/mL and 722.2 ng/mL (urine), respectively. After 4 days, the patient was discharged home.
DISCUSSION: Unique combination of clinical symptoms was a result of a simultaneous 4-FiBF and α-PiHP intoxication. To our knowledge, this is the first case of ingestion such unusual mixture of new psychoactive substances with a full description of medical treatment.
CASE DETAILS: A 29-year-old male was found out of conscious in his apartment and taken to the Intensive Care Unit. Examinations revealed pinpoint pupils, slight respiratory acidosis, leukocytosis as well as body temperature of 39.4 °C and increased creatinine with decreased eGFR level. Toxicological analysis of biological samples revealed presence of 4-FiBF and α-PiHP in concentrations: 87.7 ng/mL and 5.0 ng/mL (blood) and 2291.0 ng/mL and 722.2 ng/mL (urine), respectively. After 4 days, the patient was discharged home.
DISCUSSION: Unique combination of clinical symptoms was a result of a simultaneous 4-FiBF and α-PiHP intoxication. To our knowledge, this is the first case of ingestion such unusual mixture of new psychoactive substances with a full description of medical treatment.