AB-CHMINACA-induced sudden death from non-cardiogenic pulmonary edema
AB-CHMINACA-induced sudden death from non-cardiogenic pulmonary edema
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DOI：
10.1080/15563650.2017.1340648
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发表时间：
2018-01-01
影响因子：
3.3
通讯作者：
Yoshida, Ken-Ichi
中科院分区：
文献类型：
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作者：
Maeda, Hideyuki;Kikura-Hanajiri, Ruri;Yoshida, Ken-Ichi
背景：尽管广泛使用各种合成大麻素(SCB)化合物，但许多合成大麻素化合物(包括AB-CHMINACA)中毒的病理生理机制以及它们在血液和器官中的代谢和分布情况尚不清楚。病例细节：一名年轻人在摄入含有SCB化合物的草药产品后不久死亡。血液样本的毒理学分析显示AB-CHMINACA(7.61+/-0.59 ng/毫升)及其代谢物(M2，56.73+/-4.16毫微克/毫升；M4，2.29+/-0.14毫微克/毫升)以及微量的5-氟-AMB、FUB-PB-22和AB-FUBINACA。尸检显示严重的肺水肿，组织学显示肺泡积液中有气泡，表明水肿进展迅速。低血N末端脑利钠肽原水平排除心源性肺水肿。组织学检查显示弥漫性神经元(脑)和心肌(心内膜下)高嗜酸粒细胞增多，分别提示缺氧性脑病和全身性低氧血症。结论：AB-CHMINACA可导致肺水肿的快速进展，导致缺氧性脑病和全身性低氧血症，可能是通过严重癫痫发作。M2代谢物与母体化合物AB-CHMINACA在血液中的比例很高，表明代谢速度很快。这突出了M2的定量在诊断AB-CHMINACA中毒中的作用。
Context: Despite widespread use of diverse synthetic cannabinoid (sCB) compounds, the pathophysiology associated with intoxication with many sCB compounds, including AB-CHMINACA, is poorly understood, as is their metabolism and distribution into blood and organs.Case details: A young man died shortly after ingesting an herb product containing sCB compounds. Toxicological analyses of blood samples revealed high levels of AB-CHMINACA (7.61 +/- 0.59 ng/mL) and its metabolites (M2, 56.73 +/- 4.16 ng/mL; M4, 2.29 +/- 0.14 ng/mL) and trace amounts of 5-fluoro-AMB, FUB-PB-22, and AB-FUBINACA. The autopsy revealed severe pulmonary edema, and histology showed air bubbles in the alveolar effusion, suggesting rapid progression of edema. Low blood levels of N-terminal pro-brain natriuretic peptide excluded cardiogenic pulmonary edema. Histological examination revealed diffuse neuronal (brain) and myocardial (sub-endocardial) hyper-eosinophilia, indicating hypoxic encephalopathy and systemic hypoxemia, respectively.Conclusions: The findings show that AB-CHMINACA induced rapid progression of pulmonary edema resulting in hypoxic encephalopathy and systemic hypoxemia, possibly through severe seizures. The high blood ratio of the M2 metabolite to the parent compound, AB-CHMINACA, demonstrates rapid metabolism. This highlights the usefulness of quantification of M2 in diagnosing AB-CHMINACA intoxication.