The “Mickey Finn”

October 25, 2011, 8:07 pm

★★★☆☆

Short answer question case series: the perils of urine toxicology testing. Graubard M et al. Emerg Med J November 28:998-999.

No abstract available

This short case vignette describes a 32-year-old man who presents to the emergency department with meiosis and apnea. After responding to naloxone, he states that someone slipped him a “Mickey Finn” at a bar.  One hour later, apnea recurs and again responds to naloxone. Serum glucose, blood chemistry, head CT and urine drug screen are all negative.

The authors ask and answer the following questions: (click on the text to reveal the answer)

A “Mickey Finn” is a combination of ethanol and a sedative. Classically, the sedative is chloral hydrate. Both agents depress the central nervous system. They also each potentiate the action of the other agent. Chloral hydrate inhibits alcohol dehydrogenase, decreasing clearance of ethanol. And the metabolism of ethanol produces NADH, a cofactor to the metabolism of chloral hydrate into the long-acting toxin trichloroethanol.

Yes. Synthetic opiates — such as methadone, fentanyl, and propoxyphene — are generally not detected on urine drug screens.

No. Intoxication from non-opioid drugs — such as ethanol, tetrahydrolozine (Visine), or valpoic acid — may respond partially to administration of naloxone.

No.

To see an example of the “Mickey Finn” being used by popular culture, listen carefully to the lyrics of this song from “Annie”:

 

 

3 Comments:

  1. Rosalind Says:

    Another song that features the Mickey Finn is Richard Thompson’s “Gypsy Love Songs”:
    http://www.youtube.com/watch?v=n2XnBHwdd2k
    which includes a description of some of the dangers of imbibing same.

  2. Leon Says:

    Rosalind:

    Yes! Thank you so much for the link! I had forgotten about the mention of “Mickey Finn” in this great RT song.

    BTW, Richard Thompson is my favorite living musician. Several week ago I saw two incredible solo shows he gave at the intimate club SPACE in Evanston, IL, playing everything from a superb version of Chuck Berry’s “Little Queenie” to the sublime “Dimming of the Day”. Life doesn’t get much better than that.

  3. Rosalind Says:

    ‘BTW, Richard Thompson is my favorite living musician.’

    You and me both! Since I discovered RT in 2003, I’ve lost interest in listening to anyone else. I gave my Tom Petty CDs and my Springsteen CDs away to my kids.