methylone and Death--Sudden--Cardiac

The rise in popularity of "bath salts" as safe alternatives to MDMA (3,4-methylenedioxymethamphetamine), methamphetamine, and other illicit substances has resulted in increased scrutiny of the contents and toxicology associated with these products. We report a case of sudden death related to the synthetic cathinone methylone (3,4-methylenedioxy-N-methylcathinonmethylone) in a previously healthy 19-year-old man. Although several fatal case reports have been published involving methylone and other synthetic cathinones, this is the first reported case of sudden cardiac death associated with methylone use. Although lack of published data prevented a comparison of blood methylone concentrations between our case and existing reports, the amount of methylone we detected postmortem (0.07 mg/dL) is below those reported in MDMA-related fatalities. Our report suggests that methylone toxicity has been greatly underestimated by users of this synthetic cathinone.

Topics: Alkaloids; Central Nervous System Stimulants; Death, Sudden, Cardiac; Designer Drugs; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Humans; Male; Methamphetamine; Molecular Structure; Substance-Related Disorders; Young Adult

This report presents a fatal case related to the consumption of methylone, a relatively new cathinone type designer drug. A 16-year-old boy suddenly lost his consciousness in a party. Resuscitation had been continued for about 1.5 hours at the intensive care unit, but it was unsuccessful. His previous history included cardiac malformation detected at infancy and bronchial asthma had been diagnosed one year before his death. Signs of sudden cardiac death were observed during autopsy. Methylone intake was proved in blood and liver extract using gas chromatography/mass spectrometry; its concentration was 272 ng/ml in the blood, and 387 ng/g in the liver. Pathohistology revealed microvascular steatosis in the liver, which raised the possibility of chronic use of toxic substances. In addition, striated heart muscle damage was observed, which could be due to the use of an amphetamine-like substance. The authors presume that steatosis of the heart muscle, congenital heart disease and bronchial asthma could be predisposing factors for sudden cardiac death that occurred in the presence of relatively low levels of methylone. Access to various designer drugs is easy, fast and broad. Consequently, the potential abuse or overdose should be taken into consideration in the emergency practice. The use of "non-illicit" drugs does not require formal intervention by the authorities, but the medical service must alarm the stakeholders.

Topics: Adolescent; Amphetamine; Asthma; Autopsy; Causality; Death, Sudden, Cardiac; Designer Drugs; Drug Overdose; Fatal Outcome; Fatty Liver; Heart Defects, Congenital; Humans; Hungary; Male; Methamphetamine; Muscle, Smooth; N-Methyl-3,4-methylenedioxyamphetamine