“…Bruxism, trismus, headaches and dizziness, dissociative symptoms, as well as hyponatraemia, hyperkalaemia and metabolic acidosis are also observed [ 10 , 11 , 17 , 24 , 26 , 27 , 29 , 33 , 41 ]. Analytical evidence of the participation of piperazine designer drugs is needed for a comprehensive diagnosis [ 22 ]. This is all the more difficult as the concentrations in biological fluids may not be closely related to the clinical symptoms found [ 11 , 17 , 27 , 33 ].…”