• Lam Rex Pui Kin RPK a Emergency Medicine Unit, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Hong Kong Special Administrative Region , China., Magdalene Huen Yin Tang, Siu Chung Leung, Yeow Kuan Chong, Tsui Matthew Sik Hon MSH c Accident and Emergency Department , Queen Mary Hospital , Hong Kong Special Administrative Region , China., and Mak Tony Wing Lai TWL b Hospital Authority Toxicology Reference Laboratory , Princess Margaret Hospital, Lai Chi Kok , Hong Kong Special Administrative Region , China..
• a Emergency Medicine Unit, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Hong Kong Special Administrative Region , China.
• Clin Toxicol (Phila). 2017 Aug 1; 55 (7): 662-667.

BackgroundAB-FUBINACA and ADB-FUBINACA are structurally similar synthetic cannabinoids with potent CB1 receptor agonistic effects. Very little is known about their pharmacology and toxicology.ObjectiveTo report a case of supraventricular tachycardia and acute confusion after ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA, with quantitative analysis of the serum drug concentrations.Case ReportA healthy 24-year-old man ingested two drops of e-cigarette fluid which were later found to contain AB-FUBINACA and ADB-FUBINACA. Within 30 min of ingestion, he became somnolent, confused, and agitated, with palpitation and vomiting. On arrival to the emergency department, a short run of supraventricular tachycardia was noted, which resolved spontaneously. Bedside urine immunoassay failed to detect recreational drugs. Laboratory blood tests showed mild hypokalemia. Exposure to AB-FUBINACA and ADB-FUBINACA was confirmed analytically, with serum concentrations of 5.6 ng/mL and 15.6 ng/mL, respectively, in the blood sample collected on presentation. The patient recovered uneventfully with supportive treatment and was discharged 22 h after admission.DiscussionAB-FUBINACA and ADB-FUBINACA are orally bioavailable with rapid onset of toxicity after ingestion. In this case, supraventricular tachycardia was likely the result of exposure to AB-FUBINACA and ADB-FUBINACA. The serum concentrations of AB-FUBINACA and ADB-FUBINACA were higher than those previously reported in fatal cases.ConclusionIn the context of acute poisoning, the presence of unexplained tachyarrhythmias, confusion, and a negative recreational drug screen should prompt clinicians to consider synthetic cannabinoid toxicity as a differential diagnosis.

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