title: A fatal case of poisoning related to new cathinone designer drugs, 4-methoxy PV8, PV9, and 4-methoxy PV9, and a dissociative agent, diphenidine.
abstract: A woman in her thirties was found dead on a bed. Considerable amounts of "aroma liquid" and "bath salt" products and hypnotic drug tablets were scattered beside the bed. Autopsy showed pulmonary congestion and edema. Gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) analyses of "aroma liquid" and "bath salt" products showed the presence of new cathinone designer drugs, 4-methoxy PV8 (4-methoxy PHPP), PV9 (α-POP), and 4-methoxy PV9 (4-methoxy α-POP), and a dissociative agent, diphenidine. Drug screening in stomach contents, blood and hydrolyzed urine of the woman by GC-MS and liquid chromatography-tandem mass spectrometry (LC-MS/MS) revealed the presence of the above 4 types of drugs and 3 types of benzodiazepines, triazolam, flunitrazepam, and nitrazepam, and their metabolites. The above 7 drugs and 3 benzodiazepine metabolites were simultaneously determined by LC-MS/MS after modified QuEChERS (Quick, Easy, Cheap, Effective, Rugged, Safe) extraction using diazepam-d5 as the internal standard. The concentrations of 4-methoxy PV8, PV9, 4-methoxy PV9, and diphenidine in the femoral blood were 2.69, 0.743, 0.261, and 1.38μg/ml, respectively, which were significantly higher than concentrations reported in previous cases. Alcohol concentration in the femoral blood was 1.52mg/ml. Based on the pathological and toxicological findings, the cause of death was determined to be 3 types of cathinone drugs, 4-methoxy PV8, PV9, and 4-methoxy PV9, and diphenidine poisoning under the influence of 3 benzodiazepines and alcohol.
authors.affiliation: Department of Forensic Pathology and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Kudo
authors.affiliation: Department of Forensic Pathology and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Usumoto
authors.affiliation: Division of Pharmacognosy, Phytochemistry and Narcotics, National Institute of Health Sciences, Tokyo 158-8501, Japan.
authors.forename: Ruri
authors.initials: R
authors.lastname: Kikura-Hanajiri
authors.affiliation: Department of Forensic Pathology and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Sameshima
authors.affiliation: Department of Forensic Pathology and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tsuji
authors.affiliation: Department of Forensic Pathology and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. Electronic address: norii@forensic.med.kyushu-u.ac.jp.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D000470:Alkaloids / Q000032:analysis / Q000506:poisoning*; D001569:Benzodiazepines / Q000032:analysis; D002423:Cause of Death; D015198:Designer Drugs / Q000032:analysis / Q000506:poisoning*; D005260:Female; D006801:Humans; D010880:Piperidines / Q000032:analysis / Q000506:poisoning*; D053719:Tandem Mass Spectrometry
chemical_list: D000470:Alkaloids; D015198:Designer Drugs; D010880:Piperidines; D001569:Benzodiazepines; C023665:cathinone; C000599677:diphenidine
keywords: 4-Methoxy PV8 (4-methoxy PHPP); 4-Methoxy PV9 (4-methoxy α-POP); Diphenidine; GC–MS; LC–MS/MS; PV9 (α-POP)