New psychoactive substance cocktail in an intensive care intoxication case elucidated by molecular networking

Abstract

Background

The recreational use of new psychoactive substances (NPS) is increasing worldwide. Among them, the arylcyclohexylamine family including phencyclidine (PCP) and ketamine derivatives is increasing. We report a non-fatal intoxication mainly due to arylcyclohexylamine compounds illustrated by molecular networking (MN).

Case details

A 37-year-old man with a history of drug abuse was discovered with several bags labeled as research chemicals around him and traces of powder on his nose. He was rehydrated, intubated, and admitted to the intensive care unit (ICU). Urine and drug were analyzed by liquid chromatography-mass spectrometry for NPS identification. Several NPS were quantified in urine: 3-OH-PCP at 12,085 mg/L, 3-MeO-PCP at 1100 mg/L, 2F-DCK at 147 mg/L, N-ethylhexedrone at 165 mg/L and CMC at 48 mg/L. Using a bioinformatic approach, a molecular network was built to confirm the consumption of powders contained in the bags by comparison with patient’s urine.

Discussion

This case illustrates the interest of MN to (i) perform sample-to-sample comparison, (ii) target quantification methods, and (iii) allow proper management to confirm the relevance of the treatment.

Keywords:

• New psychoactive substances
• ketamine derivatives
• intoxication
• molecular networking
• intensive care

Acknowledgments

The authors thank MB Guilvic et Kristina for English language editing of the manuscript.

Disclosure statement

The authors declare that there is no conflict of interest.

Informed consent

Informed consent was obtained from the patient.

Additional information

Funding

No funding to declare.