title: Lethal serotonin syndrome after methylone and butylone ingestion.
abstract: BACKGROUND
  A new generation of designer phenethylamines have emerged and aggressively marketed as "legal highs." The drugs are labeled "not for human consumption" to avoid widespread recognition and prosecution under the existing analog drug laws. The newest generation includes methylone and butylone. Methylone and butylone have minor structural changes and similar pharmacodynamics properties to scheduled drugs.
  
  
  METHODS
  We report a case of a healthy 24-year-old who ingested a capsule containing methylone and butylone sold as "Ecstasy" at a concert. The patient presented to the emergency department, comatose febrile, tachycardic, tachypnic, and hypertensive. On exam, she was diaphoretic, tremulous, hyperreflexic, and had sustained clonus. The patient was aggressively cooled, and despite maximal supportive care, the patient progressed to multi-system organ failure and ultimately expired. We obtained and analyzed both her urine and a capsule found on her person similar to the capsules ingested. In both samples, laboratory analysis identified only methylone and butylone.
  
  
  CONCLUSIONS
  This is the first reported death for methylone or butylone and the first human or animal ingestion of butylone. Clinicians and public health officials should work together as new designer drugs emerge.
authors.affiliation: Children's Hospital of Michigan Poison Control Center, Detroit, MI 48201, USA. brandon_warrick@hotmail.com
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Warrick
authors.forename: John
authors.initials: J
authors.lastname: Wilson
authors.forename: Matthew
authors.initials: M
authors.lastname: Hedge
authors.forename: Scott
authors.initials: S
authors.lastname: Freeman
authors.forename: Karen
authors.initials: K
authors.lastname: Leonard
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aaron
mesh_terms: D015104:3,4-Methylenedioxyamphetamine / Q000031:analogs & derivatives* / Q000506:poisoning; D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008694:Methamphetamine / Q000031:analogs & derivatives* / Q000506:poisoning; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000506:poisoning; D020230:Serotonin Syndrome / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D008694:Methamphetamine; D015104:3,4-Methylenedioxyamphetamine; D018817:N-Methyl-3,4-methylenedioxyamphetamine; C400939:methylone; C544130:2-methylamino-1-(3,4-methylenedioxyphenyl)butan-1-one