Supraventricular tachycardia and acute confusion following ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA: a case report with quantitative analysis of serum drug concentrations

Clin Toxicol (Phila). 2017 Aug;55(7):662-667. doi: 10.1080/15563650.2017.1307385. Epub 2017 Apr 10.


Background: AB-FUBINACA and ADB-FUBINACA are structurally similar synthetic cannabinoids with potent CB1 receptor agonistic effects. Very little is known about their pharmacology and toxicology.

Objective: To report a case of supraventricular tachycardia and acute confusion after ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA, with quantitative analysis of the serum drug concentrations.

Case report: A healthy 24-year-old man ingested two drops of e-cigarette fluid which were later found to contain AB-FUBINACA and ADB-FUBINACA. Within 30 min of ingestion, he became somnolent, confused, and agitated, with palpitation and vomiting. On arrival to the emergency department, a short run of supraventricular tachycardia was noted, which resolved spontaneously. Bedside urine immunoassay failed to detect recreational drugs. Laboratory blood tests showed mild hypokalemia. Exposure to AB-FUBINACA and ADB-FUBINACA was confirmed analytically, with serum concentrations of 5.6 ng/mL and 15.6 ng/mL, respectively, in the blood sample collected on presentation. The patient recovered uneventfully with supportive treatment and was discharged 22 h after admission.

Discussion: AB-FUBINACA and ADB-FUBINACA are orally bioavailable with rapid onset of toxicity after ingestion. In this case, supraventricular tachycardia was likely the result of exposure to AB-FUBINACA and ADB-FUBINACA. The serum concentrations of AB-FUBINACA and ADB-FUBINACA were higher than those previously reported in fatal cases.

Conclusion: In the context of acute poisoning, the presence of unexplained tachyarrhythmias, confusion, and a negative recreational drug screen should prompt clinicians to consider synthetic cannabinoid toxicity as a differential diagnosis.

Keywords: Synthetic cannabinoids; cardiac arrhythmias; designer drug; novel psychoactive substances; toxicity.

Publication types

  • Case Reports

MeSH terms

  • Confusion / chemically induced*
  • Confusion / diagnosis
  • Confusion / psychology
  • Confusion / therapy
  • Diagnosis, Differential
  • Drug Overdose* / blood
  • Drug Overdose* / diagnosis
  • Electronic Nicotine Delivery Systems / adverse effects*
  • Humans
  • Indazoles / blood
  • Indazoles / poisoning*
  • Male
  • Predictive Value of Tests
  • Substance Abuse Detection
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / etiology*
  • Substance-Related Disorders / physiopathology
  • Substance-Related Disorders / therapy
  • Tachycardia, Supraventricular / chemically induced*
  • Tachycardia, Supraventricular / diagnosis
  • Tachycardia, Supraventricular / physiopathology
  • Tachycardia, Supraventricular / therapy
  • Treatment Outcome
  • Young Adult


  • Indazoles