Aim Raise awareness of Dextromethorphan consumption (DXM or DM) as a recreational drug, used by teenagers, a medication which normally is used as an opioid antitussive treatment. In Romania, it’s a prescription only medication. DXM’s toxicities can develop depending on the dose, and exactly those manifestations are sought by consumer. These symptoms of serotonin syndrome include mental state changes, vegetative system instability, neuromuscular and gastrointestinal disturbances. In our clinical practice we noticed also acute urinary retention.

Material and Method We present the case of a 15 years old young man, from urban area, who presents to the Paediatric ED as unable to pass urine for past 16 hours. On examination he is alert, looking uncomfortable as general appearance, with a distended abdomen, spontaneously tender and on palpation of the hypogastric region, with palpable, tender and distended urinary bladder. Also, from the rest of the general examination, worth mentioning is his bilateral mydriasis. After reviewing all clinical investigations and imaging (which excluded probable medical causes), and retaking extensive history, the patient admits suicidal intention by voluntarily ingesting 12 tablets of 30 mg dextromethorphan (total 240 mg) taken around 18h prior to the acute urinary retention onset. The overdose can result in hallucinations and euphoria, which contradicts the statement of suicide ideation, to conceal illicit drug use.

Results There has recently been noted a shift in the behaviour of young Romanians, resulting in an increase in the consumption of illicit substances. This behaviour is driven by seeking validation and curiosity to experience new sensation.

Conclusions Due to their novelty and easy accessibility, new psychoactive substances, aside from cannabis and opioids, have become prevalent in the presenting clinical picture to emergency departments. In any illicit substance consumption, it is crucial to have a rapid diagnosis and appropriate emergency treatment.