Abstracts

Rationale: Nymphaea caerulea, otherwise known as “Egyptian Lotus” or “Blue Lotus,” is a flowering plant that possesses two psychoactive compounds, apomorphine and nuciferine [1]. Abuse of Blue Lotus has become a recent trend with active duty servicemembers [2] because of its hallucinogenic properties and inability to be detected on routine drug screens. Due to Blue Lotus’ unregulated status in the United States, it can easily be purchased online. While very little is known of this drug, the minimal literature available reports only behavioral abnormalities and electrolyte derangements [3] seen with Blue Lotus toxicity. We present a novel case of Blue Lotus-induced seizures that has yet to be reported in the literature. 

Methods: Case Report: A 22-year-old active duty man was found down by his roommate and taken to the local emergency department, where he was reported to have a generalized tonic-clonic seizure. The seizure was aborted with lorazepam, and he was transferred to our hospital for a higher level of care. On arrival, his neurologic exam was notable for akathisia, retrograde and anterograde amnesia, and dysarthria. He was also found to have an acute kidney and liver injury. While hospitalized, he had two additional generalized tonic-clonic seizures and was started on levetiracetam for seizure control.

Results: A thorough evaluation including drug screen, lumbar puncture, imaging, and EEG showed no abnormalities. The patient later disclosed that he had been vaping approximately five mL per day of Blue Lotus for the past three weeks. The patient had obtained the drug from another active duty servicemember, who had purchased the drug online. On discharge, the patient was advised to discontinue Blue Lotus, given seizure precautions, and continued levetiracetam with close follow-up.

Conclusions: Blue Lotus is easily obtained, undetectable by routine drug screen, and has the potential to provoke seizures, retrograde amnesia, and akathisia in otherwise young and healthy individuals. The trend of Blue Lotus drug abuse is anticipated to become more widespread in the coming months. As use of Blue Lotus becomes more pervasive, it’s critical for medical providers to recognize the drug and understand its devastating complications.

References: 
[1] Farrell, M. S., et al. (2016). "In Vitro and In Vivo Characterization of the Alkaloid Nuciferine." PLoS One 11(3): e0150602
[2] Toxicity From Blue Lotus (Nymphaea caerulea) After Ingestion or Inhalation: A Case Series, Military Medicine, 2021;, usab328, https://doi.org/10.1093/milmed/usab328 
[3] Poklis, J. L., et al. (2017). "The Blue Lotus Flower (Nymphea caerulea) Resin Used in a New Type of Electronic Cigarette, the Re-Buildable Dripping Atomizer." J Psychoactive Drugs 49(3): 175-181.

Funding: Please list any funding that was received in support of this abstract.: n/a.