title: Recreational use of mephedrone (4-methylmethcathinone, 4-MMC) with associated sympathomimetic toxicity.
abstract: BACKGROUND
  Cathinone is a pharmacologically active alkaloid that can be extracted from the leaves of the khat plant (Catha edulis). There are synthetic derivatives of cathinone entering the recreational drug market, including mephedrone (4-methylmethcathinone, 4-MMC). There are discrepancies in the legal status of both the khat plant and its extracted alkaloids between the UK and the USA.
  
  
  METHODS
  A 22-year-old man purchased 4 g of mephedrone powder over the Internet from a chemical supplier based in China. He initially ingested 200 mg of the mephedrone orally, with no perceived clinical effects, and thereafter injected the remaining 3.8 g intramuscularly into his thighs. Shortly after the injection, he developed palpitations, "blurred tunnel vision," chest pressure, and sweating and felt generally unwell; he presented to hospital with continuing features of sympathomimetic toxicity. His symptoms settled over the next 4 h after a single dose of oral lorazepam. Qualitative analysis of the urine and serum sample was undertaken using gas chromatography with mass spectrometric (GC/MS) detection, both positive for the presence of 4-methylmethcathinone. Quantitative analysis of the serum sample was undertaken by liquid chromatography with tandem mass spectrometric detection; the estimated mephedrone concentration was 0.15 mg/l. Routine toxicological analysis of the serum and urine specimens using a broad GC/MS toxicology screen did not detect any other drugs or alcohol.
  
  
  CONCLUSIONS
  This is the first case of isolated 4-MMC toxicity, with confirmatory analytical findings. It is important that clinical toxicologists and emergency physicians work together to ensure a better understanding of the toxicity of novel/emerging drugs such as 4-MMC.
authors.affiliation: Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust and King's Health Partners, London, UK. David.Wood@gstt.nhs.uk
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
authors.forename: Susannah
authors.initials: S
authors.lastname: Davies
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Puchnarewicz
authors.forename: Jenny
authors.initials: J
authors.lastname: Button
authors.forename: Roland
authors.initials: R
authors.lastname: Archer
authors.forename: Hanna
authors.initials: H
authors.lastname: Ovaska
authors.forename: John
authors.initials: J
authors.lastname: Ramsey
authors.forename: Terry
authors.initials: T
authors.lastname: Lee
authors.forename: David W
authors.initials: DW
authors.lastname: Holt
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
mesh_terms: D000328:Adult; D006801:Humans; D013287:Illicit Drugs / Q000633:toxicity*; D008297:Male; D008694:Methamphetamine / Q000031:analogs & derivatives* / Q000633:toxicity; D013566:Sympathomimetics / Q000633:toxicity*
chemical_list: D013287:Illicit Drugs; D013566:Sympathomimetics; D008694:Methamphetamine; C548233:mephedrone