Acute toxicity of ADB‐CHMINACA ‐ a case series of patients with pronounced central nervous symptoms including the posterior reversible encephalopathic syndrome

AIM: This report presents a series of 16 patients who were admitted to the emergency department following confirmed intake of the potent synthetic cannabinoid ADB-CHMINACA. METHODS: The cases are drawn from a prospective observational study following the recreational use of synthetic cannabinoids. The clinical and analytical data were combined and submitted to a Poison Centre. The severity of poisoning was evaluated on the basis of clinical data, including follow-up information. The present analysis was conducted exclusively on patients with analytically confirmed intake of ADB-CHMINACA and treatment in emergency departments for acute adverse effects. Cases with additional relevant serum concentrations of other drugs of abuse that suggested relevant interactions were excluded. RESULTS: Common clinical manifestations included panic attacks, tachycardia, agitation, vomiting and seizures. Most of the patients experienced these symptoms within minutes after inhaling this new psychoactive substance. Serum concentrations of ADB-CHMINACA varied widely and ranged from 0.2-31 ng/mL, without a clear correlation between severity of the poisoning and drug concentration. Severity of poisoning was moderate to severe, but all patients recovered. Notably, 1 of the patients developed a posterior reversible encephalopathy syndrome, a rare but serious neurological complication characterised by usually transient symptoms like headaches, seizures and altered mental state, often accompanied by brain oedema. In this case, the patient recovered after 4 days. CONCLUSION: Clinical presentations exhibited by patients with analytically confirmed intake of ADB-CHMINACA showed similarities to previous reports; neuropsychiatric and cardiovascular symptoms were most prominent. Notable distinctions include the prevalence of panic attacks and trembling.