Acute Limb Ischemia after Intake of the Phenylethylamine Derivate NBOMe

Patricia P. Wadowski, Georgiana-Aura Giurgea, Oliver Schlager, Anton Luf, Thomas Gremmel, Eva-Luise Hobl, Sylvia Unterhumer, Henriette Löffler-Stastka and Renate Koppensteiner
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Patricia P. Wadowski: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria
Georgiana-Aura Giurgea: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria
Oliver Schlager: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria
Anton Luf: Department of Laboratory Medicine, Medical University of Vienna, A-1090 Vienna, Austria
Thomas Gremmel: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria
Eva-Luise Hobl: Department of Clinical Pharmacology, Medical University of Vienna, A-1090 Vienna, Austria
Sylvia Unterhumer: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, A-1090 Vienna, Austria
Henriette Löffler-Stastka: Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria
Renate Koppensteiner: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria

IJERPH, 2019, vol. 16, issue 24, 1-7

Abstract: Objective : N-(2-methoxy) benzyl-phenethylamine (NBOMe) derivatives have a high affinity to the serotonin receptor 2A and emerged as new psychedelic agents. We report the case of a 30-year-old man admitted to the hospital because of acute ischemia of the left arm with clinical symptoms of pallor, pulselessness, paresthesia, and a motoric deficit. The patient had a history of schizophrenia and drug abuse and disclosed during the hospital stay the sublingual intake of a substance bought as 25I-NBOMe the night before the ischemic event. Methods : Routine clinical diagnostics including among others color-coded duplex sonography and computed tomography angiography (CTA) were performed. The remainder of the drugs was analyzed using high performance liquid chromatography. Results : Initial color-coded duplex sonography of the upper left limb showed pathological flow profiles of the axillary, brachial, ulnar, and radial artery with a reduced diameter of the ulnar (0.9 mm) and radial (1.1 mm) artery. In consequence, peripheral vasospasm, distal arterial thrombosis, or arterial embolization was anticipated. As therapeutic measures, the patient immediately received intravenous systemic vasodilators (alprostadil) and therapeutic anticoagulation with low molecular weight heparin. Instant symptom improvement was observed within the first day after therapy initiation. The subsequently performed CTA of the heart and left arm showed no signs of thrombotic material. Treatment was continued for five days and the patient was released thereafter having completely normalized perfusion in his left arm. Outpatient treatment was continued with calcium-channel blockers, as the patient had also displayed arterial hypertension. Drug analysis retrieved a composition of the isomers 25I-NBOMe, 25C-NBOMe, and 25H-NBOMe as well as traces of pentylon. Conclusion: NBOMe ingestion implicates the risk of peripheral vasospasms with severe, limb-threatening ischemia.

Keywords: upper limb pain; limb ischemia; vasospasm; phenylethylamine derivates (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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