Synthetic cannabinoid ("bonsai") induced rhabdomyolysis; two case reports

Synthetic cannabinoid (SC) products are called "Spice" in Europe, "K2" in the United States and "Bonsai" in Turkey and sold under the counter. Widespread uses of these substances and lack of specific regulations about them cause serious problems. It is not very clear what these psychoactive products contain and how much and how often they can be given. Their metabolic effects are not known well either. There is not much known about the effects of SCs other than the ones on the neurological and cardiovascular systems. In this report, we presented two cases of rhabdomyolysis developing after bonsai consumption and requiring dialysis. Two bonsai users have been brought to our emergency department in an unconscious state. Their physical examinations were normal except tachicardia. Laboratory investigations revealed increased urea, serum creatinine, creatinine phosphokinase, lactate dehydrogenase and transaminase levels. The histories of the cases suggested that they had rhabdomyolysis due to cannabinoid use. A single session hemodialysis was performed for both cases. Their clinical appearance reached to stabilisation in the second hospital day and blood tests were normalised in one week. The patients were discharged at the end of the week with the normal laboratory results and psyciatric recommendations. These two cases underline the risk of rhabdomyolysis development, apart from well-known side effects of SCs.