![]() ![]() The specimens were tested by previously validated high-performance liquid chromatography/mass spectrometry assays. ![]() Blood specimens from the patient were sent to the Department of Pathology at Virginia Commonwealth University (USA) for NBOMe detection and quantification. NBOMe assays are not currently part of routine emergency toxicology testing worldwide, only a few forensic and commercial laboratories offer qualitative NBOMe testing in blood or urine. He was discharged well on Day 5 without complications. His creatinine levels peaked at 246 mM 37.5 hours after ingestion, and his creatine kinase levels peaked at 34 778 U/L (RR, 1–370 U/L) 90 hours after ingestion. Except for some initial nausea that lasted for 24 hours after extubation, he had no other symptoms over the next 3 days, and experienced no hallucinations or agitation. He was transferred to the paediatric ward, and on Day 2 his creatinine and creatine kinase levels were rising, with normal urine output ( Figure). He remained haemodynamically stable and was extubated the following day. His overnight urine output was initially reduced this improved with increased fluid replacement. He had no further seizures after his transfer to the tertiary intensive care unit. Over the next 3 hours and before medical retrieval, his blood gases normalised with improved ventilation (pH 7.4 PCO 2, 29.6 mmHg). His heart rate was 70 bpm, his blood pressure 130/60 mmHg, and he was afebrile after intubation. He was then intubated, ventilated, paralysed with rocuronium, and sedated with morphine/midazolam for transfer to a tertiary intensive care unit. His initial venous blood gas parameters were: pH 6.93 (reference range, 7.35–7.45) PCO 2, 120 mmHg (RR, 35–48 mmHg) and base excess, −7 (RR, 0.5–1.6). He had a fourth seizure about 1 hour after presenting, and was given 5 mg midazolam intravenously. He had three seizures before arriving in the ED, where his Glasgow coma scale score was 9. He had no past medical or mental health history, and was taking no regular medications. Statistics, epidemiology and research designġ6-year-old male presented to the emergency department after ingesting what he believed to be LSD (lysergic acid diethylamide) on red blotting paper while camping with friends in rural New South Wales in late 2014.
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