Confirmed mephedrone-associated fatality
December 24, 2010, 2:17 pm
Case series of individuals with analytically confirmed acute mephedrone toxicity. Wood DM et al. Clin Toxicol 2010;48:924-927.
Previously, only a single case of confirmed mephedrone (4-methylmethcathinone) exposure had been reported in the medical literature. Other papers have been based on the patient’s history of using mephedrone, which for various reasons may not be reliable. This is the first case series based on detailed toxicological analysis.
The authors studied a convenience sample of emergency department patients who reported using mephedrone and had acute toxicity assumed to be related to the drug. Serum samples were analyzed by mass-spectrometry and liquid chromatography for mephedrone and other drugs of abuse.
Mephedrone exposure was confirmed in 7 of the 9 patients studied.(The other two presented more than 24 hours after reported use.) The most common signs and symptoms were agitation (4 patients), palpitations (2), chest pain (2), and seizures (2). Five patients had a heart rate > 100; in one patient the heart rate was greater than 140. Three patients had pre-defined “significant” hypertension (systolic > 160 mmHg). No patient had a temperature > 39.0oC. The authors conclude mephedrone toxicity presents with features consistent with the acute sympathomimetic toxidrome.
This is an interesting paper, and the authors are to be commended for their initiative in pursuing laboratory confirmation in these cases. This is, admittedly, a small sample. Also, by selecting these cases on the basis of history and “acute toxicity assumed to be related to mephedrone”, the research design opened the door to severe selection bias, where patients might have been enrolled because their presentation conformed to the authors’ belief (almost certainly justified) that mephedrone was a sympathomimetic.
Although — strangely — it is not even mentioned in the abstract, one of these seven cases was a fatality. A 29-year-old man was taken to hospital with altered mental status after collapsing at a nightclub. Work-up revealed hyponatremia (sodium 125 mmol/L) consistent with water intoxication. The patient had a generalized seizure in the emergency department. Head CT showed cerebral edema and tonsillar herniation. The patient was admitted to the ICU but died in hospital. A white powder found in the patient’s clothing tested positive for mephedrone, as did biological samples from the patient. No other recreational drugs were detected in an extended screen of both the powder and biological samples. The coroner reported the cause of death as “hypoxic brain injury due to cerebral edema following ingestion of a psychoactive substance”.
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