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In addition, sometimes the substance or substances used do not correspond to those that the user believes he/she has taken, in the sense that the effects produced may be different from those expected. We report a poisoning case caused by methyl 2-[1-(5-fluoropentyl)-1H-indazole-3-carboxamido]-3,3-dimethylbutanoate (5-fluoro-ADB) synthetic cannabinoid, sold to the patient as if it were ketamine.</p><p id="par0010" class="elsevierStylePara elsevierViewall">32-year-old male patient, regular cannabis and ketamine consumer, undergoing follow-up in a health care center. The patient is under treatment with quetiapine and lormetazepam. He came to the emergency department because, after having taken what the patient believed to be ketamine, 15<span class="elsevierStyleHsp" style=""></span>h earlier, he started to experience dizziness, perception of rotating objects, coordination anomalies and spasmodic rigidity that worsened with movement. He had no fever, seizures, urine color changes or alterations in the level of consciousness. As he reported, this symptomatology was different from what he had experienced with previous ketamine intakes. The physical examination showed normal blood pressure and heart rate, afebrile, conscious, with Glasgow 15, intermittent generalized dystonia that increased with flexion of the joints, finger-nose and heel-knee dysmetria, blepharospasm and impaired gait that prevented him from walking. Other examinations through medical devices were normal. The blood count was normal and a toxic urine determination (immunochromatography) was positive for benzodiazepines, amphetamines and THC. The patient remained under observation, including neurological re-assessments and regular monitoring. A progressive improvement was observed 6<span class="elsevierStyleHsp" style=""></span>h after admission. Dysmetria disappeared and he was able to walk normally. Therefore, the patient requested his voluntary discharge. In view of the discrepancy between the symptoms observed and the symptoms associated with ketamine consumption, a plasma sample was collected before discharge for the determination of toxins by means of liquid chromatography and mass spectrometry (LC-MS) in tandem, identifying the presence of 5-fluoro-ADB cannabinoid.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This is one of the first cases of 5-fluoro-ADB<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> poisoning described in Spain, a synthetic cannabinoid that is part of the new designer drugs known as new psychoactive substances. Synthetic cannabinoids have greater potency and greater affinity for the CB1 receptor than cannabis, acting as complete agonists. In addition, its metabolites continue to have a high affinity for the CB1 receptor, extending its effect.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> These substances cannot be detected when a poisoned patient comes to the emergency services, since they only have urine toxicity tests based on immunoassay techniques, which do not detect all the existing substances and have important limitations, such as false positives and false negatives. For their detection, LC-MS techniques must be performed, which allows to detect very small amounts of substances and their metabolites in blood and urine with very good sensitivity and specificity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In this case, the patient had self-limiting acute cerebellar symptoms for about 24<span class="elsevierStyleHsp" style=""></span>h, which did not correspond to the symptoms normally associated with ketamine consumption. Cannabinoids can affect the level of consciousness from stupor to agitation, as well as vomiting, sinus tachycardia and mydriasis,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> with cases reporting chest pain, seizures, acute renal failure and hypertensive crisis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">5-Fluoro-ADB is a new, particularly harmful, synthetic cannabinoid first identified in 2014 in post-mortem samples of a patient who died after consuming a product containing this cannabinoid and has been linked to 10 deaths caused by recreational drugs in Japan.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In our case the symptomatology reverted spontaneously at 24<span class="elsevierStyleHsp" style=""></span>h of its consumption. Emergency physicians should know the existence of these substances and their introduction in our country, due to its potential danger.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, if a patient presents with symptoms which are not compatible with the substance(s) that he/she reports to having consumed, the presence of different toxins must be suspected. In these cases, given the limitations of urine screening tests available in the emergency departments, performing confirmatory chromatographic tests is recommended.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Zattera L, Errasti J, Supervía A. Intoxicación por el cannabinoide sintético 5-fluoro-ABD, adquirido como ketamina. Med Clin (Barc). 2018;151:168.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute intoxication caused by synthetic cannabinoids 5F-ADB and MMB-2201: a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Barceló" 1 => "S. Pichini" 2 => "V. López-Corominas" 3 => "I. Gomila" 4 => "C. Yates" 5 => "F.P. 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Journal Information
Vol. 151. Issue 4.
Pages 168 (August 2018)
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Vol. 151. Issue 4.
Pages 168 (August 2018)
Letter to the Editor
Intoxication by the synthetic cannabinoid 5-fluoro-ABD, acquired as ketamine
Intoxicación por el cannabinoide sintético 5-fluoro-ABD, adquirido como ketamina
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