title: Reporting Two Fatalities Associated with the Use of 4-Methylethcathinone (4-MEC) and a Review of the Literature.
abstract: We report two fatalities that are related to the cathinone 4-methylethcathinone (4-MEC) and review the current knowledge of 4-MEC. Qualitative and quantitative analysis of 4-MEC was performed by validated high performance liquid chromatography-tandem mass spectrometry methods. In the first case a 22-year-old male died in hospital following collapse and seizures after using 4-MEC. Toxicological analysis of postmortem femoral blood revealed the presence of 4-MEC (0.167 mg/L), ethanol (27 mg/100 mL) and paracetamol (5 mg/L). Death was attributed solely to 4-MEC toxicity. The second case involved a 54-year-old man found with a taped plastic bag over his head. Toxicological analysis of postmortem femoral blood revealed the presence of 4-MEC (1.73 mg/L) along with ethanol (229 mg/100 mL), propranolol (0.036 mg/L), venlafaxine (0.284 mg/L) and its metabolite O-desmethylvenlafaxine (0.205 mg/L), and diazepam (<0.005 mg/L) and its metabolite nordiazepam (0.033 mg/L). Death was attributed primarily to asphyxiation. These cases and a review of the current knowledge of 4-MEC pharmacology/toxicology adds to the body of case material for 4-MEC and will assist with interpretation in postmortem toxicology cases in which 4-MEC is detected.
authors.affiliation: Forensic Toxicology Unit, Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester, Leicester Royal Infirmary Leicester, LE1 5WW, UK.
authors.forename: P R
authors.initials: PR
authors.lastname: Smith
authors.affiliation: Forensic Toxicology Unit, Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester, Leicester Royal Infirmary Leicester, LE1 5WW, UK.
authors.forename: R
authors.initials: R
authors.lastname: Cole
authors.affiliation: East Midlands Forensic Pathology Unit, University of Leicester, Robert Kilpatrick Building, Leicester LE2 7LX, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hamilton
authors.affiliation: Department of Histopathology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
authors.forename: K
authors.initials: K
authors.lastname: West
authors.affiliation: Forensic Toxicology Unit, Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester, Leicester Royal Infirmary Leicester, LE1 5WW, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Morley
authors.affiliation: Department of Chemical and Forensic Sciences, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK p.d.maskell@hud.ac.uk.
authors.forename: P D
authors.initials: PD
authors.lastname: Maskell
mesh_terms: D000662:Amphetamines / Q000378:metabolism* / Q000506:poisoning; D062787:Drug Overdose / Q000175:diagnosis*; D017809:Fatal Outcome; D053593:Forensic Toxicology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011427:Propiophenones / Q000378:metabolism* / Q000506:poisoning; D055815:Young Adult
chemical_list: D000662:Amphetamines; D011427:Propiophenones; C585202:4-methylethcathinone