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Analytical findings of an acute intoxication after inhalation of methoxetamine
Laurent Imbert1, Alexandra Boucher2, Gilles Delhome3
1Department of Pharmacology and Toxicology, University Hospital, Limoges 87042, France laurent.imbert@ch-havre.fr.
Abstract:
Methoxetamine (MXE) is increasingly used and abused, as it is frequently presented as being safer than ketamine, and legal. Cases of only MXE consumption being associated with the occurrence of seizures are rarely reported. A single MXE intoxication case by inhalation is described concerning a 21-year-old man, not known to be epileptic, who was found collapsed in his bedroom, supposedly after an epileptic seizure. He was transferred to the Emergency Department of the Henri Mondor Hospital, Aurillac, France. He was conscious, but with a sinus bradycardia (48/min) and an ST-segment elevation on the electrocardiogram, and a slightly increased creatine kinase level (270 U/L) and hyponatremia (127 mmol/L). New seizure activity occurred during hospitalization, but the clinical course in the intensive care unit was favorable. Quantitation of MXE in serum and urine using gas chromatography coupled to mass spectrometry (GC-MS) was developed, as well as a liquid chromatography coupled to tandem mass spectrometry (LC-MS-MS) method for the determination of MXE in hair. Limits of detection and quantification were, respectively, 2 and 10 µg/L for the GC-MS method and both 0.5 pg/mg for the LC-MS-MS method. Concentrations of 30 and 408 µg/L were, respectively, measured in serum and urine. Concentrations of 135 and 145 pg/mg were detected in two 2.5 cm hair strands, consistent with one or several consumptions during the 2 ½ months prior to sampling. A sample of the powder consumed was available and also analyzed. This case illustrates the dangers of this drug, which justify its classification as a narcotic in France since August 2013.
Insights
Methoxetamine (MXE) intoxication can cause seizures, even in individuals without epilepsy. This case highlights the drug
Area of Science:
- Forensic Toxicology
- Clinical Toxicology
- Neuropharmacology
Background:
- Methoxetamine (MXE) is a dissociative anesthetic drug with increasing recreational use.
- MXE is often perceived as a safer alternative to ketamine.
- Seizures solely attributed to MXE consumption are infrequently documented.
Observation:
- A 21-year-old male, with no prior history of epilepsy, experienced collapse and suspected seizures after inhaling MXE.
- Clinical presentation included sinus bradycardia, ST-segment elevation, elevated creatine kinase, and hyponatremia.
- Recurrent seizure activity occurred during hospitalization, but the patient's condition improved in the intensive care unit.
Findings:
- Developed and validated sensitive analytical methods for MXE detection in biological matrices: GC-MS for serum/urine and LC-MS-MS for hair.
- Quantified MXE in serum (30 µg/L) and urine (408 µg/L).
- Detected MXE in hair strands (135-145 pg/mg), indicating consumption within the preceding 2.5 months.
Implications:
- This case underscores the potential neurological dangers associated with MXE use, including seizure induction.
- The findings support the classification of MXE as a narcotic substance.
- Highlights the importance of forensic toxicology in identifying novel psychoactive substances and their clinical effects.