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Pediatria Polska - Polish Journal of Paediatrics
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6/2019
vol. 94
 
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abstract:
Original paper

Atypical profile of intoxication with the mix of new psychoactive substances

Andrzej Załęski
1
,
Natalia Dudek
2
,
Anna Borowska
3
,
Agnieszka Korzeń
4
,
Paweł Szpot
5
,
Marta Rorat
5
,
Tomasz Jurek
5
,
Ernest Kuchar
2

  1. Department of Infectious Diseases, Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
  2. Department of Paediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
  3. Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
  4. Department of Paediatrics, Prof. Jan Bogdanowicz Children’s Hospital, Warsaw, Poland
  5. Chair and Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
Pediatr Pol 2019; 94 (6): 351–356
DOI: https://doi.org/10.5114/polp.2019.92969
Online publish date: 2019/12/31
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Introduction
In recent years an increase in the intake of new psychoactive substances (NPS) has been observed in the Polish adolescent population. Synthetic cathinones are a group of evolving drugs with stimulating, mind-altering effects. We report a case series of intentional intoxication with NPS and its atypical clinical course of poisoning.

Material and methods
This study was approved by the Bioethical Committee of the Medical University of Warsaw (No. AKBE/166/2019). Clinical data of three adolescent patients intoxicated with NPS were admitted to two paediatric hospitals in Warsaw and retrospectively analysed. The composition of the preparation found in the patients was confirmed by the reference forensic laboratory. Analysed data from the medical records included: anthropometry, the route of poisoning, Glasgow Coma Scale (GCS), and Poisoning Severity Score (PSS) assessment, as well as the evaluation of vital signs and biochemistry of the peripheral blood.

Results
All of the patients admitted that they had taken intranasally a designer drug called HEX-EN. The patients had disturbances of consciousness with a minimum of eight points in the Paediatric GCS. Two patients were aggressive. All of them developed hypotension and bradycardia at some point of hospitalisation. Moreover, all the patients had an affected respiratory system and muscle stiffness. Two of them had elevated creatine kinase serum level. Two patients showed features of liver damage. The nervous and muscular systems of all the patients were affected in at least a moderate grade. Toxicological analysis of white powder found on the inside walls of a plastic bag revealed a mix of cathinone derivatives: 3-CMC, N-ethylhexedrone (HEX-EN), synthetic cannabinoids, and caffeine.

Conclusions
In most cases, the side effects of NPS result in consciousness disturbances, seizures, hyperthermia, hypertension, and tachycardia. Due to differences in composition and concentration of active substances contained in NPS products, intoxication symptoms are unpredictable and may require different symptomatic treatment.

keywords:

adolescents, HEX-EN, designed drugs, N-ethylhexedrone, 3-CMC