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Acute methoxetamine and amphetamine poisoning with fatal outcome: a case report
Marek Wiergowski1, Jacek Sein Anand, Maciej Krzyżanowski
1Department of Forensic Medicine, Medical University of Gdansk, Gdańsk, Poland, marwier@gumed.edu.pl.
Abstract:
Methoxetamine (MXE) is a psychoactive substance distributed mostly via the Internet and is not liable to legal regulation in Poland. MXE has a toxicity profile similar to that of ketamine but longer-lasting effects. The paper describes a case of acute poisoning that resulted from recreational use of MXE and amphetamine and ended in death. In mid-July 2012, a 31-year old man was admitted to the clinical toxicology unit in Gdańsk because of poisoning with an unknown psychoactive substance. The patient was transported to the emergency department (ED) at 5:15 a.m. in a very poor general condition, in a deep coma, with acute respiratory failure, hyperthermia (> 39°C) and generalized seizures. Laboratory tests showed marked leukocytosis, signs of massive rhabdomyolysis, hepatic failure and beginning of acute renal failure. Despite intensive therapy, the patient died 4 weeks after the poisoning in the course of multi-organ dysfunction syndrome. Chemical and toxicological studies of serum and urine samples collected on the poisoning day at 1:40 p.m. confirmed that amphetamine and MXE had been taken earlier that day. Concentration of amphetamine in the serum (0.06 μg/ml) was within the non-toxic range, while MXE (0.32 μg/ml) was within the toxic range of concentrations. Amphetamine was also detected in the patient's hair, which suggested a possibility of its use within the last dozen weeks or so. The serious clinical course of intoxication and co-existence of amphetamine and MXE in the patient's blood and urine suggest the possibility of adverse interactions between them.
Insights
A fatal case of poisoning involved methoxetamine (MXE) and amphetamine. The patient experienced severe symptoms including coma and multi-organ failure, highlighting potential adverse drug interactions.
Area of Science:
- Toxicology
- Pharmacology
- Forensic Science
Background:
- Methoxetamine (MXE) is an unregulated psychoactive substance with ketamine-like effects.
- Recreational drug use, particularly of novel psychoactive substances, poses public health challenges.
- Understanding the toxicity and interactions of substances like MXE is crucial for clinical management.
Observation:
- A 31-year-old male presented with acute poisoning after recreational use of MXE and amphetamine.
- The patient exhibited deep coma, respiratory failure, hyperthermia, seizures, rhabdomyolysis, and multi-organ dysfunction.
- Post-mortem analysis confirmed toxic levels of MXE and non-toxic levels of amphetamine in serum.
Findings:
- Serum MXE concentration was 0.32 μg/ml (toxic range), while amphetamine was 0.06 μg/ml (non-toxic range).
- Amphetamine was also detected in hair samples, indicating recent or chronic use.
- The patient died 4 weeks post-intoxication due to multi-organ dysfunction syndrome.
Implications:
- This case underscores the severe toxicity of MXE, especially when combined with other substances.
- Adverse interactions between MXE and amphetamine may have contributed to the fatal outcome.
- The findings highlight the need for increased regulation and awareness of novel psychoactive substances like MXE.