A cluster of 25B-NBOH poisonings following exposure to powder sold as lysergic acid diethylamide (LSD).
25B-NBOH is a synthetic hallucinogen closely related to the NBOMe family of N-substituted 2C phenethylamine derivatives. There have been no published reports documenting the clinical toxicity of NBOH derivatives. Five patients presented to the Emergency Department (ED) with altered conscious state following exposure to powder sold as powdered LSD at a party. A 24-year-old male who ingested the powder developed mydriasis, tachycardia, hypertension, and severe agitation requiring parenteral sedation. A 22-year-old male who insufflated the powder developed status epilepticus requiring intubation. Both patients developed acute kidney injury and one had rhabdomyolysis. In both cases, blood analysis detected 25-NBOH and no other illicitlicit drugs. Three other patients developed mild hallucinations. Hyperthermia was not documented in any case. Exposure to 25B-NBOH in a powdered form produced sympathomimetic toxicity, including hallucinations. Insufflation of 25B-NBOH led to rapid onset of status epilepticus in one case. Toxicity in all cases resolved within 12 h. Despite