A fatal case involving the highest ever reported 4-CMC concentration

Area of Science:

• Forensic Toxicology
• Analytical Chemistry
• Pharmacology

Background:

• Synthetic cathinones, including mephedrone (4-MMC) and 4-chloro-N-methylcathinone (4-CMC), are prevalent on the dark market.
• Recreational drug users often encounter novel psychoactive substances (NPS), leading to risks of accidental poisoning due to misidentification.

Observation:

• A 22-year-old male presented with altered consciousness, dilated pupils, and metabolic acidosis after party ingestion of a substance presumed to be mephedrone.
• The patient died within one hour of emergency room admission.

Findings:

• Autopsy analysis of blood and vitreous humor detected extremely high concentrations of 4-CMC (8542 ng/ml and 9874 ng/ml, respectively).
• The analytical method utilized ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-QqQ-MS/MS) with liquid-liquid extraction.
• Other detected substances included atropine, diazepam, lidocaine, norlidocaine, methcathinone, and ethyl alcohol.

Implications:

• This case reports the highest 4-CMC concentration ever documented, underscoring its potential toxicity.
• Accidental ingestion of misidentified NPS, such as 4-CMC mistaken for 4-MMC, poses a significant public health threat.
• Accurate and sensitive analytical methods are crucial for identifying NPS in forensic toxicology cases.