Identification of sinicuichi alkaloids in human serum after intoxication caused by oral intake of a Heimia salicifolia extract

A 26-year-old male came to hospital around midnight complaining about muscle pain of the extremities as well as the tongue and slightly raised temperature. He reported the intake of an unknown amount of sinicuichi tea he had fermented over 24 h by adding yeast and sugar. The patient was treated with Vomex A (dimenhydrinate) and released from hospital the following afternoon. A blood sample taken shortly after submission and a small amount of the used plant material were available for analysis. Herbal drugs are widely used as stimulants as a legal alternative to illegal psychoactive drugs or in traditional context. Among many others like Sassafras officinalis, Salvia divinorum or Ephedra, Heimia salicifolia ("sinicuichi"), a species of the lythraceae family, is available via several online shops. Brewed up or fermented and consumed, the so-called sinicuichi tea may cause exhilarating feelings and an alteration of awareness accompanied by bradycardia, relaxation of the muscles and a pleasant faintness. Therefore Sinicuichi brew and heimia leaves are widely used for medication by the natives of Central and South America. After liquid extraction with acetone five different alkaloids were detected in the plant material by LC-MS/MS operated in the Q1 scan mode applying a TurboIonSpray source. Subsequently, Product Ion Spectra were recorded and after confirming the molecular formula by determining the accurate masses, possible structures of H. salicifolia alkaloids were assigned. The information of the Product Ion Spectra was then used to set up a sensitive multiple reaction monitoring (MRM) method. Applying the MRM method to the patient's serum sample after alkaline liquid-liquid extraction all of the five heimia alkaloids detected in the plant material were also detected qualitatively in the serum extract, confirming the ingestion.