On the internet, nobody knows if it’s 25C-NBOMe (“N-bomb”)

25C-NBOMe (N-bomb)

25C-NBOMe (N-bomb)

2 out of 5 stars

25C-NBOMe: Preliminary Data on Pharmacology, Psychoactive Effects, and Toxicity of a New Potent and Dangerous Hallucinogenic Drug. Bersani FS et al. Biomed Res Int 2014;2014:734749. Epub 2014 Jul 3.

Full Text

The NBOMe drugs are phenethylamine derivatives of the 2C psychedelics. The 2 methoxybenzyl groups act to provide protection and stability, drastically increasing the potency of this drug. Although sometimes sold as LSD, 25C- NBOMe (N-bomb) is much more potent and dangerous.

This article uses both published scientific literature and discussions on Web bulletin boards and chat groups in an attempt to define the effects of this drug. The authors argue that since the internet is a crucial factor in marketing and disseminating novel psychoactive substances and since peer-reviewed articles about these substances are scarce, using unconfirmed anecdotal reports on sites like Bluelight and Drugs-Forum is justified.

I don’t buy it. However, the authors do reference several medical papers about N-bomb. for example,  a recent article by Grautoff and Kahler described a 19-year-old man who supposedly snorted N-bomb and developed seizures, acute kidney failure and acute lung failure. Unfortunately, the article is in German and the abstract does not specify whether the exposure was laboratory-confirmed.

 

 

Tox Tunes #85: Goodnight, Irene (Jerry Lee Lewis and Van Morrison)

http://www.youtube.com/watch?v=wmvCAzLseu8

Goodnight, Irene” was introduced by the folksinger and blues musician Lead Belly (Huddie Ledbetter, 1888-1949) and became a big hit for The Weavers in 1950. This fascinating song tells a somewhat murky story about unrequited passion and suicidal fantasies. The Weavers, however, left out the reference to opiates in Lead Belly’s original lyrics:

I love Irene
I swear I do
I love her ’til the sea runs dry
If Irene turns her back on me
I’m gonna take morphine and die.

Jerry Lee Lewis and Van Morrison keep this verse in their version.

Lead Belly’s original also implies love for a girl who is possibly underage, and also — at least to my interpretation — hints of murder. It limns a story that is much more coherent:

http://www.youtube.com/watch?v=dRHHhObYMKE

And here is The Weavers’ hit version from 1950. It is a much tamer, much less dangerous song. And I’ve never forgiven them for those awful strings:

http://www.youtube.com/watch?v=s5aixNi_C1Q

 

Review of scorpion envenomation

Asian forest scorpion

Asian forest scorpion

3 out of 5 stars

Scorpion Envenomation. Isbister GK, Bawaskar HS. N Engl J Med 2014 Jul 31;371:457-463.

Reference

“O! full of scorpions is my mind, dear wife!”
Macbeth

With over 1700 species of scorpions found all over the world, this brief review article is much too short and unfocused to provide more than a superficial overview of its topic.

The authors point out that most scorpion stings cause, at most, minor toxicity with pain and other local effects only. Most serious envenomations are associated with the Buthidae family, which include the genus Centruroidesseveral of which are found in North America and commonly cause neuromuscular excitation.

Major toxicity is associated with α-toxins, which inhibit deactivation of voltage-gated sodium channels causing sympathetic and parasympathetic autonomic excitation, as well as the release of catecholamines epinephrine and norepinephrine. This can result in:

  • hypertension
  • myocardial injury
  • cardiogenic shock
  • impaired left ventricular function
  • hypotension
  • cardiac conduction abnormalities
  • pulmonary edema

Features of the sympathomimetic or cholinergic toxidromes can be prominent.

Use of antivenom in cases of scorpion stings is controversial, and this article really doesn’t provide much enlightenment regarding the pros and cons. The authors do note that although antivenom would seem to be more useful in cases of clinically severe envenomation, by the time clinical severity is apparent it may be rather late in the game — although antivenom can bind toxins and prevent progression, it does not reverse established injury. (A list of scorpion antivenoms available worldwide, as well as a summary of the effects of envenomation, can be found here.)

This fascinating video, featuring Dr. Leslie Boyer from the University of Arizona, makes the case for use of antivenom in stings by the Arizona bark scorpion (Centruroides sculpturatus):

http://www.youtube.com/watch?v=DE60ig0CIZc

Microcystin: the hepatotoxin that shut down Toledo’s water supply

 

Microcystin-LR

Microcystin-LR

3.5 out of 5 stars

The Toxicology of Microcystins. Dawson RM. Toxicon 1998;36:953-962.

Abstract

Just when you thought it was safe to go back to the faucet . . .

While I was on vacation, the big toxicology story involved contamination of the water supply to Toledo Ohio. As a result almost half a million people in the area were warned not to drink — or even shower with — water from Lake Erie.

The cause was a bloom of freshwater cyanobacteria, resulting from increased levels of phosphates and fertilizer. These cyanobacteria product microcystin, a heat-stable hepatotoxin. Microcystin can cause 3 clinical syndromes:

  1. Gastroenteritis (nausea, vomiting,diarrhea)
  2. Allergic and irritant reactions on local contact
  3. Liver damage

Microcystin interferes with the function of the hepatic cytoskeleton, causing necrosis and massive liver hemorrhage. Death is from hemorrhagic shock. Since the toxin is heat-stable, boiling water will just increase the concentration. Likewise, treating with chlorine may kill the organism and result in increased toxin release.

Hepatotoxicity requires that toxin be transported into the liver cell, a process that is blocked by the antibiotic rifampin. Administering rifampin prior to, or at the time of, microcystin exposure can be protective — at least in mice. It is not clear if this can provide any clinical benefit in human cases.

In 1996, 50 patients at a dialysis center in Brazil died of acute liver failure after exposure to water contaminated with microcystin.

Nicotine liquid fatality — but was it from intravenous injection?

e-cig photo2.5 out of 5 stars

Fatal Intravenous Injection of Electronic Nicotine Delivery System Refilling Solution. Thornton SL et al. J Med Toxicol 2014;10:202-204.

Reference

Well, any case report of a fatality following exposure to e-cigarette nicotine  refill liquid is interesting, but this one has problems.

Lately, TPR has been whinging about the BuzzFeed-ificiation of the medical literature, especially with regard to titles of published papers. In this process, nuanced topics and cases are simplified to produce a misleading title that serves better as clickbait.

This case report describes  29-year-old male who was found at home in asystolic cardiac arrest. He had left a suicide note saying that he had injected eLiquid intravenously. On arrival at hospital after resuscitation in the field, he had a pulse (125/min) and a blood pressure (158/93 mmHg). In the emergency department he developed tonic-clonic seizure activity. He was treated with support, antiepileptic medication, and therapeutic hypothermia. Work-up revealed evidence of anoxic encephalopathy. He never regained consciousness, and was pronounced brain dead on the 5th hospital day. Serum nicotine level was 2,000 ng/ml (“normal” range 5-90 ng/ml).

This is an interesting case, but aside from the suicide note, there was apparently no evidence that this was an intravenous overdose. No injection site was found. The paper does not state that IV paraphernalia was found at the scene, so I assumed that it wasn’t. On the basis of the information in the paper, it seems to me this was much more likely an ingestion.