GC/MS analysis of an herbal dietary supplement containing ephedrine

An unconscious 20-year-old female was admitted to hospital with a heart rate of 164, a blood pressure of 132/90 mmHg, and hypokalemia. "Triage" urine screening tests were negative on arrival and 12 h later. The next day, her SGOT and SGPT levels rose remarkably; however, on the third day, the patient regained consciousness. Two Japanese OTC drugs and an American herbal dietary supplement ("7th heaven") were found in her room. The supplement and the patient's samples were analyzed using GC/MS. Ephedrine (2.32 mg/g) and caffeine (17.96 mg/g) were detected in the supplement and in the patient's serum (0.627 mg/L, 383 mg/L, respectively), as well as acetaminophen, bromvalerylurea, and etenzamide, which are constituents of the OTC drugs. The serum ephedrine concentration was above the therapeutic level but did not reach the fatal level. The acetaminophen concentration was sufficient to cause liver damage. Although a prescription is necessary to obtain products containing ephedrine in Japan, this patient had no prescription. Thus, how the patient obtained the drug and the amount ingested were unclear. Information about acquisition of drugs via the Internet or magazine advertisements is constantly changing and unreliable. Thus, it is indispensable to analyze unfamiliar supplements found with patients.