A 17-year-old male experienced seizures, systemic inflammatory response, and rhabdomyolysis after taking what he thought was LSD, but laboratory testing confirmed exposure to the designer drugs 4-iodo-2,5-dimethoxyphenethylamine (2C-I) and its n-benzyloxymethyl analog (25I-NBOMe). Seizures resolved with midazolam, but he required intubation. His urine drug screen was negative. Creatine kinase peaked at 14,579 U/L, and creatinine at 2.46 mg/dL. He recovered fully with intravenous fluids and was discharged after five days. The 2C drugs and their analogs are potent serotonergic agents associated with severe toxicity including seizures, rhabdomyolysis, and death, and should be considered in cases of drug-induced seizures.
A 19-year-old woman had two seizures and dangerously low sodium after taking "ecstasy" at a rave. Laboratory analysis of her blood and urine showed she had taken both MDMA and 3,4-DMA, and that her body produced very low levels of MDMA's CYP2D6 metabolites, indicating impaired metabolism through that pathway. The case suggests that combining MDMA with 3,4-DMA can lead to severe toxicity, including hyponatremia and seizures. Healthcare providers should be aware that people using illicit drugs may take multiple substances, and that such combinations can cause serious harm.