title: Postmortem tissue distribution of MDPV following lethal intoxication by "bath salts".
abstract: 3,4-Methylenedioxypyrovalerone (MDPV) is a psychoactive, synthetic analog of the central nervous system stimulant cathinone. Its recent popularity as a recreational drug in the United States has led to numerous reports to poison control centers across the country. As with other synthetic cathinones, the recreational use of MDPV has resulted in death. MDPV is thought to exert its pharmacologic effects by inhibiting the reuptake of dopamine and norepinephrine. This report describes the case of an exposure of a 39-year-old male to MDPV, which resulted in his death. Postmortem concentrations of MDPV in various tissues were measured. The detection of MDPV in tissues and fluids was accomplished using gas chromatography-mass spectrometry analysis after solid-phase extraction. Blood analysis also demonstrated therapeutic levels of lamotrigine, fluoxetine, risperidone, benztropine, pseudoephedrine and ibuprofen. The detection of cathinones in hair was conducted using high-performance liquid chromatography-tandem mass spectrometry after solid-phase extraction. MDPV was uniformly distributed among multiple tissues (blood, brain, muscle, cerebrospinal fluid and lung) at concentrations of approximately 0.4 to 0.6 µg/mL. Tissue and fluids responsible for detoxification/excretion had higher concentrations of MDPV (kidney, liver and bile > 0.8 µg/mL). A blood concentration ≥ 0.4 µg/mL was judged sufficient to cause death. The cause of death was ruled MDPV intoxication resulting in cardiac arrhythmia.
authors: Cuyahoga County Regional Forensic Science Lab, Cuyahoga County Medical Examiner's Office, Cleveland, OH, USA. jfwyman@cuyahogacounty.us
authors: John F
authors: JF
authors: Wyman
authors: Eric S
authors: ES
authors: Lavins
authors: David
authors: D
authors: Engelhart
authors: Erica J
authors: EJ
authors: Armstrong
authors: Kimberly D
authors: KD
authors: Snell
authors: Paul D
authors: PD
authors: Boggs
authors: Shaena M
authors: SM
authors: Taylor
authors: Rindi N
authors: RN
authors: Norris
authors: Frank P
authors: FP
authors: Miller
mesh_terms: D000328:Adult; D000470:Alkaloids / Q000378:metabolism; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000175:diagnosis*; D001344:Autopsy; D001494:Baths; D052117:Benzodioxoles / Q000097:blood / Q000134:cerebrospinal fluid / Q000506:poisoning*; D001921:Brain / Q000378:metabolism; D002423:Cause of Death; D002851:Chromatography, High Pressure Liquid; D015198:Designer Drugs / Q000378:metabolism / Q000506:poisoning*; D017809:Fatal Outcome; D053593:Forensic Toxicology / Q000379:methods; D008401:Gas Chromatography-Mass Spectrometry; D006197:Hair / Q000378:metabolism; D006801:Humans; D008168:Lung / Q000378:metabolism; D008297:Male; D018482:Muscle, Skeletal / Q000378:metabolism; D011619:Psychotropic Drugs / Q000097:blood / Q000134:cerebrospinal fluid / Q000506:poisoning*; D011759:Pyrrolidines / Q000097:blood / Q000134:cerebrospinal fluid / Q000506:poisoning*; D052616:Solid Phase Extraction; D015813:Substance Abuse Detection / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D053719:Tandem Mass Spectrometry; D014018:Tissue Distribution; D000094982:Synthetic Cathinone
chemical_list: D000470:Alkaloids; D052117:Benzodioxoles; D015198:Designer Drugs; D011619:Psychotropic Drugs; D011759:Pyrrolidines; C023665:cathinone; D000094982:Synthetic Cathinone