Table 1.

Summary of published reports of toxic effects of NBOMe ingestion in humans.

Reference	N	Product consumed by user	Analytically confirmed product(s)	Quantitative Analysis of product consumed	Patient Characteristic	Effects	Management and outcomes
Armenian and Gerona 2014 (12)	1	3 hits of “acid” on blotter paper taken sublingually or orally	25C-NBOMe, 25I-NBOMe	not quantified	24 Caucasian F with “many” prior LSD use	Neuropsychiatric: Agitated delirium Autonomic: Tachycardia 140bpm, tachypnea 32/min; pupils 5mm; skin was moist and hot to the touch Others: Not reported Laboratory abnormalities: Not reported Routine urine toxicology: Not reported	IV fluids and lorazepam, and full recovery within 10 hours of ingestion.
Hill, et al. 2013 (17)	7	Intravenous injection of “3ml” of 25I-NBOMe	25I-NBOMe, 2C-I, amphetamine (trace), methamphet-amine (trace)	not quantified	29 M	Neuropsychiatric: Seizures, severe agitation, aggression, self injurious behavior, myoclonus Autonomic: tachycardia 160bpm, hypertension 187/171mmHg, tachypnea 58/min, temp 102.2F, dilated pupils Other: Anuria, ARDS, pulmonary abscess, loss of corticomedullary differentiation of renal parenchyma Laboratory abnormalities: serum pH 7.2, WBC 23.5 ×109/L, CK 15424 U/L, ALT 121 U/L Routine urine toxicology: not reported	Intubation and ventilation, and intravenous sedation with propofol and midazolam and vasopressor support. Percutaneous tracheostomy on day 18. Producing urine on day 27, and discharged from ICU on day 38. Normalized renal function by discharge on day 43.
		1 cap of “2C-B” taken orally	25I-NBOMe, 2C-I, amphetamine (trace), methamphet-amine (trace)	not quantified	20 M with history of depression	Neuropsychiatric: Seizures, agitation Autonomic: Tachycardia 126bpm, hyptertension 170/90mmHg, tachypnea 24/min, temp 101.5, dilated pupils Others: sustained clonus, ocular clonus, nystagmus, urinary retention, serotonin syndrome Laboratory abnormalities: serum pH 7.3, peak CK 550 U/L on day 1 Routine urine toxicology: not reported	Initially given diazepam, then intubated, and pressure-control ventilation commenced, maintaining anesthesia with infusions of propofol and midazolam. Treated with lorazepam and cypropheptadine for presumed serotonin syndrome. Extubated on day 3, and discharged at Day 5.
		Insufflated a “small amount” of “2C-B”	25I-NBOMe, amphetamine (trace), methamphet-amine (trace)	not quantified	19 M with regular cannabis use	Neuropsychiatric: Auditory and visual hallucinations, derealization, and severe agitated with aggression Autonomic: tachycardia 110bpm, hypertension 138/100, dilated pupils to 9mm reactive to light Others:None Laboratory abnormalities: WBC 18.9×109/L, CK 326 U/L Routine urine toxicology: not reported	Diazepam to control agitation. Discharged 15 hours after ingestion.
		Insufflated an unknown quantity of “2C-B”	25I-NBOMe, amphetamine (trace), methamphet-amine (trace)	not quantified	22M	Neuropsychiatric: Seizure, agitation, visual hallucination, Autonomic: tachycardia 104bpm, dilated pupils Others: Nausea, dizziness Laboratory abnormalities: peak CK 633 U/L on day 1 Routine urine toxicology: not reported	Diazepam to control agitation. Discharged 15 hours after ingestion.
		Insufflated 100mg of “2C-B”	25I-NBOMe, amphetamine (trace), methamphet-amine (trace)	Not quantified	21 M with history of asthma	Neuropsychiatric: Severe agitation, aggression, hallucinations Autonomic: tachycardia 160bpm, hypertension 150/80mmHg, temp 101.1F, dilated pupils Others: None reported Laboratory abnormalities: WBC 11.1×109/L, CK 598 U/L Routine urine toxicology: not reported	Diazepam, lorazepam, and haloperidol to manage agitation. Discharged 15 hours after ingestion.
		One capsule of “2C-B” taken orally	25I-NBOMe, 2C-I, amphetamine (trace), methamphet-amine (trace)	not quantified	20 M with regular user of amphetamine and MDMA	Neuropsychiatric: Visual hallucinations Autonomic: Tachycardia 131bpm, hypertension 132/67, dilated pupils Others: palpitations, ankle clonus Laboratory abnormalities:none Routine urine toxicology: not reported	Hallucinations resolved, and discharged 15 hours after ingestion.
		One capsule of “2C-B” taken orally	25I-NBOMe, 2C-I, amphetamine (trace), methamphet-amine (trace)	not quantified	20 M with regular cocaine, cannabis, and MDMA use	Neuropsychiatric: Visual and auditory hallucinations Autonomic: tachycardia 125bpm, hypertension 154/90, dilated pupils, diaphoresis, clammy skin Others: Palpitations Laboratory abnormalities: None Routine urine toxicology: not reported	Hallucinations resolved, and discharged 15 hours after ingestion.
Kelly et al. 2012 (18)	3	Unknown quantity of “25I-NBOMe” ingested either by mouth or insufflated	25I-NBOMe	Urine concentration: 2ng/ml	Male age 18–19	Neuropsychiatric: Agitated delirium Autonomic: Tachycardia 122bpm Others: Not reported Laboratory abnormalities: Glucose 239mg/dL Routine urine toxicology: Caffeine	Did not require mechanical ventilation, and outcome of hospitalization not described
		Unknown quantity of “25I-NBOMe” ingested either by mouth or insufflated	25I-NBOMe	36ng/ml	Male age 18–19	Neuropsychiatric: Seizure, agitated delirium Autonomic: Tachycardia 153bpm; hypertension 148/49 mmHg Others: Not reported Laboratory abnormalities: Glucose 292mg/dL Routine urine toxicology: Caffeine	Required intubation and mechanical ventilation, and outcome of hospitalization not described
		Unknown quantity of “25I-NBOMe” ingested either by mouth or insufflated	25I-NBOMe	28ng/ml	Male age 18–19	Neuropsychiatric: Seizure activity, agitated delirium Autonomics: Tachycardia 184bpm Others: Rhabdomyolysis, renal failure. Laboratory abnormalities: CK 30,000U/L Routine urine toxicology: Caffeine, nicotine	Required intubation and mechanical ventilation, and developed renal failure from rhabdomyolysis requiring hemodialysis. Outcome of hospitalization not described
Poklis et al., 2013 (15)	1	Unknown quantity of “25B” taken through unknown route	25B-NBOMe	serum concentration: 0.180ng/ml urine concentration: 1.9ng/ml	19 M with no known prior history of alcohol or drug use, or psychiatric illness	Neuropsychiatric: Status epilepticus, agitation; diaphoresis with facial cyanosis Autonomic: fever up to 104F; tachycardia 152bpm, hypertension 145/90mmHg, tachypnea 22rpm Others: purpuric rash on forehead; rhabdomyolysis Laboratory findings: initial blood gas pH 6.9 and pCO2 89mmHg, glucose 286mg/L, potassium 5.9mEq/L, creatinine 1.6 mg/dL, WBC 26.1×109/L, peak CK 11,645 on day 5 Routine urine toxicology: THC	Seizure control with multiple doses of lorazepam and dilantin loading, and ventilator support with propofol and midazolam. Extubated on day 3, and was fully alert and oriented by day 6.
Poklis, et al., 2014 (14)	1	One blotter of “acid” taken sublingually or orally	25I-NBOMe	serum concentration: 0.405ng/ml urine concentration: 2.8ng/ml	19 M with no known prior history of alcohol or drug use, or psychiatric illness	Neuropsychiatric: delirium Autonomic: Not described Others: Not described Laboratory findings: Not performed Routine urine toxicology: Negative	Fell or jumped from apartment balcony. Pronounced dead at the scene. Autopsy findings: Multiple blunt impact injuries, lacerations to heart, aorta, liver, spleen. Multiple skull fractures, subdural and subarachnoid hemorrhages and cortical contusions and axonal injury. Heart blood and ocular fluid negative for common drugs of abuse including targeted analysis for LSD and volatile drugs.
Rose, et al. 2013 (13)	1	Unknown quantity of “25I-NBOMe” taken through unknown route	25I-NBOMe	serum concentration: 0.76ng/mL	18 M	Neuropsychiatric: Severe agitation, aggression and hallucinations Autonomic: tachycardia 138bpm. Hypertension 150–170/110, pupils 6–7mm Others: None Laboratory abnormalities: Potassium 2.8 mEq/L, creatinine 1.4mg/L, glucose 192mg/dL, WBC 18,200 U/L Routine urine toxicology: THC	IV fluids and lorazepam then admitted to the ICU. Patient remained agitated, requiring restraints in addition to continued lorazepam infusion and dexmedetomidine. Over the next 24 h, patient continued to have episodes of aggressiveness and was started on oral ziprasidone treatment. Final disposition not described.
Stellpflug et al. 2013 (16)	1	Unknown quantity of “25I-NBOMe” taken sublingually	25I-NBOMe, 25H-NBOMe, 2C-I	urine concentration: 25I-NBOMe:7.5ng/mL 25H-NBOMe: 0.9ng/mL 2C-I: 1.8ng/mL	18 F with moderate alcohol use and regular marijuana use	Neuropsychiatric: seizure, agitated delirium; pressured speech, hyperreflexia Autonomic: tachycardia 145bpm; hypertension 145/100mmHg, cutaneous flushing, pupils 7–8mm minimally reactive Laboratory abnormalities: fingerstick blood glucose 11.82 mmol/L, others not done Routine urine toxicology: not reported.	Improved with IV fluids and lorazepam, discharged after 5 hours of observation
Suzuki et al 2014 (21)	1	2 hits of “LSD” taken sublingually	25I-NBOMe	Serum concentration: 0.034ng/ml	18 Asian M with history of marijuana use	Neuropsychiatric: visual hallucinations, suicide attempt by stabbing self in neck and chest Autonomics: hypertension 140/84mmHg, tachypnea 20/min, dilated pupils 5mm Others: 12cm stab wound in anterior neck, two 8cm stab wounds in right lateral neck, and a 2cm penetrating stab wound to left anterior chest wall. Chest x-ray showing left pneumothorax and pleural effusion Laboratory abnormalities: All within normal limits Routine urine toxicology: THC	Arrived in ED 11 hours after ingestion, alert and oriented. No longer under the influence but anxious. After insertion of chest tube, sent to operating room for wound exploration and closure. Suicidal ideation resolved, and transferred to an inpatient psychiatric unit 3 days after admission.
Tang et al. 2014 (20)	2	One pill of “NBOMe” taken orally	25B-NBOMe	not quantified	17 Caucasian M with history of recreational cannabis use	Neuropsychiatric: Seizure, agitated delirium Autonomic: tachycardia 140bpm, hypertension 215/94mmHg Laboratory abnormalities: peak CK 11066 U/L on Day 1, ALT 463 U/L, AST 492 U/L Routine urine toxicology: not reported	IV diazepam for seizure control then intubated with midalozam and rocuronium infusion.Fully conscious 12 hours after admission, and discharged on day 5.
		Half a packet of “Holland film” taken sublingually	25B-NBOMe, 25C-NBOMe	not quantified	31 Asian M with history of “substance abuse”	Neuropsychiatric: Agitated delirium Autonomic: Tachycardia 162bpm, hypertension 160/123mmHg, Fevers 39.6C, diaphoresis, pupils 5mm Others: elevated troponin and lactate; rhabdomyolysis; impaired renal function; transaminitis Routine urine toxicology: not reported	IV lorazepam, ice packs for physical cooling. Insisted on leaving hospital on day 3.
Walterscheid et al. 2014 (19)	2	2 hits of “acid” taken through unknown route	25I-NBOMe	not quantified	21 M with daily marijuana use	Neuropsychiatric: Hallucinations, severe agitation, aggression Autonomic: Not described Others: None reported Laboratory abnormalities: Not reported Routine urine toxicology: Not reported	Unresponsive in vehicle. Pronounced dead at the scene. Autopsy findings: Numerous scattered, linear, and confluent contusions and ecchymoses of the face, head, chest, back, arms, and legs; few petechial hemorrhages on the palpebral surfaces on the conjunctivae; hemorrhage in subcutaneous corresponding to cutaneous contusions; hematomas in back and shoulder; lung parenchyma moderately congested and edemetous
		“Unknown clear liquid” taken through unknown route	25I-NBOMe, THC (trace)	not quantified	15Caucasian F with marijuana and MDMA use	Neuropsychiatric: Agitation Autonomic: asystole, rectal temp 103.8F Others: Not reported Laboratory abnormalities: Not reported Routine urine toxicology: Not reported	Found screaming in tent, and transferred to hospital. Pronounced dead on arrival. Autopsy findings: Numerous areas of abrasion and contusion over shoulders and upper extremities, left hip, right buttock, and left thigh and shins. Subscapular hemorrhages in frontal, parietal and occipital regions. Copious amounts of white foam in trachea and bronchi.