title: Three fatal intoxications due to methylone.
abstract: We present three fatal intoxications of methylone, a cathinone derivative. Blood was analyzed with a routine alkaline liquid-liquid extraction and analyzed by gas chromatography coupled with a mass spectrometer (GC-MS). Methylone was identified by a full scan mass spectral comparison to an analytical standard of methylone. For a definitive and conclusive confirmation and quantitation, methylone was also derivatized with heptafluorobutyric anhydride and analyzed by GC-MS. In all three fatalities, the deceased exhibited seizure-like activity and elevated body temperatures (103.9, 105.9 and 107°F) before death. Two of the three cases also exhibited metabolic acidosis. One of the three cases had prolonged treatment and hospitalization before death with symptoms similar to sympathomimetic toxicity, including metabolic acidosis, rhabdomyolysis, acute renal failure and disseminated intravascular coagulation. The laboratory results for this patient over the 24 h period of hospitalization were significant for increased lactate, liver transaminases, creatinine, myoglobin, creatine kinase and clotting times, and decreased pH, glucose and calcium. Peripheral blood methylone concentrations in the three fatal cases were 0.84, 3.3 and 0.56 mg/L. In conlusion, peripheral blood methylone concentrations in excess of 0.5 mg/L may result in death due to its toxic properties, which can include elevated body temperature and other sympathomimetic-like symptoms.
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL, USA. pearsonjm@hillsboroughcounty.org
authors.forename: Julia M
authors.initials: JM
authors.lastname: Pearson
authors.forename: Tiffanie L
authors.initials: TL
authors.lastname: Hargraves
authors.forename: Laura S
authors.initials: LS
authors.lastname: Hair
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Massucci
authors.forename: C Clinton
authors.initials: CC
authors.lastname: Frazee
authors.forename: Uttam
authors.initials: U
authors.lastname: Garg
authors.forename: B Robert
authors.initials: BR
authors.lastname: Pietak
mesh_terms: D000138:Acidosis / Q000209:etiology; D000328:Adult; D000697:Central Nervous System Stimulants / Q000097:blood / Q000633:toxicity*; D017809:Fatal Outcome; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D013287:Illicit Drugs / Q000097:blood / Q000633:toxicity*; D008297:Male; D008694:Methamphetamine / Q000031:analogs & derivatives* / Q000097:blood / Q000633:toxicity; D011605:Psychoses, Substance-Induced / Q000503:physiopathology / Q000628:therapy*; D012640:Seizures / Q000209:etiology; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D013287:Illicit Drugs; D008694:Methamphetamine; C400939:methylone