N-ethyl-pentedrone poisoning as a cause of serotonin syndrome and gastrointestinal bleeding: a case report and literature review

The authors present a case of a 24-year-old man addicted to psychoactive substances who, after taking N-ethyl-pentedrone, lost consciousness and suffered from acute respiratory failure. The man exhibited symptoms of serotonin syndrome. Upon admission to the Emergency Department, no signs of gastrointestinal bleeding were observed. The patient experienced strong stimulation of serotonin receptors. Toxicological tests in blood and urine revealed the presence of N-ethyl-pentedrone. The unconscious patient, in severe condition with features of multi-organ failure, was transferred to the Department of Anesthesiology and Intensive Care. Despite the administration of maximum doses of catecholamines, the patient's blood pressure progressively dropped. Six hours after hospital admission, the man experienced cardiac arrest in the form of pulseless electrical activity, which progressed to asystole. Despite intensive resuscitation efforts, the patient was declared deceased. The autopsy revealed inflammatory infiltration, hemorrhagic changes, and erosion of the mucous membrane in the stomach. Toxicological testing using LC/MS on material secured during the autopsy showed the presence of N-ethyl-pentedrone at concentrations of 566 ng/ml in blood and 9725 ng/ml in urine. Based on this case and a review of English-language literature, the authors discuss the most common complications that can occur after taking N-ethyl-pentedrone.