Death from methylone ingestion
August 1, 2012, 11:56 pm
Three Fatal Intoxications Due to Methylone. Pearson JM et al. J Anal Toxicol 2012;36:444-451.
As is typical of articles in Journal of Analytical Toxicology, there’s much technical information concerning the measurement of drug levels here that will be of minimal interest to clinicians. However, the paper also contains 3 fascinating case histories describing fatality associated with methylone.
Methylone is a cathinone derivative often found in “bath salts” and other similar products. It is a potently inhibits norepinephrine re-uptake, and also promotes cellular release of dopamine and serotonin, as well as norepinephrine. Its effects are similar to those of methamphetamine.
- Case 1: A 23-yearold man was found walking into traffic, banging on cars and shouting obscenities, as well as “yelling out rap song lyrics and speaking different languages.” In the emergency department he was combative and required 5 staff members to restrain him. He was hyperthermic (105.9oF) and hypotensive. Despite treatment that included cooling and fluids, he developed metabolic acidosis, rhabdomyolysis, acute renal failure, seizures, and DIC. After suffering multiple cardiac arrests, he died 24 hours after admission.
- Case 2: A 19-year-old woman ingested a pill known as “molly” at a concert. After suffering 2 seizures, she was asystolic on arrival at hospital. An axillary temperature was measured at 103.9oF. She could not be resuscitated.
- Case 3: A 23-yer-old man went to a club and ingested a substance believed to be LSD. After he began acting erratically, club security personnel tied him to a chair with plastic food wrap and placed him in the back of a van. He was found seizing in the van 3 or 4 hours later. On arrival at hospital, his core temperature was 107oF and his blood pH 7.04. He died 45 minutes after admission to the emergency department.
Features common to these cases included severe sympathomimetic signs and symptoms, including hyperthermia, seizure activity, and metabolic acidosis. Blood samples of all 3 patients were positive for methylone, but negative for mephedrone, methedrone, and MDPV. Although it is not clear from the paper, apparently no LSD or methamphetamine was detected. Extensive laboratory results are provided for Case 1 throughout his 24-hour hospital course.