Six synthetic cannabinoid users developed multiple organ failure, including the first case requiring a liver transplant

All six patients had altered mental status and severe rhabdomyolysis (peak CK up to >320,000 U/L). Five of six had acute kidney injury, four required continuous dialysis. Five had fever, three had myocardial injury. Two needed emergency fasciotomies for compartment syndrome. Two developed fulminant liver failure, one requiring MARS therapy as bridge to successful transplant; the other patient without it died.

Multicenter descriptive case series of six patients admitted to intensive care units at three Maryland hospitals between March-July 2016 with known synthetic cannabinoid use and multiple organ failure.

This case series documents the most severe end of the synthetic cannabinoid toxicity spectrum, including the first reported case requiring liver transplantation. It demonstrates that SC use can cause simultaneous failure of multiple organ systems.

As synthetic cannabinoid use grows, clinicians need to recognize that these substances can cause catastrophic multi-organ failure requiring ICU-level care, dialysis, and potentially organ transplantation. The range and severity of organ damage far exceeds anything seen with natural cannabis.

Small case series from a single geographic region and time period. Specific synthetic cannabinoid compounds were not identified. Pre-existing conditions or co-ingestants may have contributed. Cannot determine incidence of severe outcomes among all SC users.