Fatal Polydrug Intoxication Involving Synthetic Cathinones in Taiwan: A Case Series and Emergency Management...

Synthetic cathinones (SC) are a class of psychoactive stimulants structurally similar to amphetamines. Despite a high prevalence of SC detection in emergency department (ED) drug surveillance in Taiwan, detailed reports of SC-related fatalities and their acute clinical course in the emergency medicine literature are limited. This case series describes the presentations, clinical course, and outcomes of four fatal SC-associated intoxications, highlighting critical emergency management insights.

We report four fatalities involving young, previously healthy adults in Taiwan, all presenting with severe sympathomimetic toxidrome. All patients presented with extreme hyperthermia (core temperature of > 40°C) and severe metabolic acidosis (blood gas pH < 7.0). Life-threatening complications included refractory ventricular tachycardia leading to cardiac arrest in three cases, status epilepticus, rhabdomyolysis, and rapid progression to multiorgan failure. Postmortem toxicology confirmed the presence of multiple SC (including mephedrone and N-ethylpentylone) and co-ingestion of other stimulants (e.g., PMMA, methamphetamine, ketamine) in all patients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: SC intoxication, particularly when combined with polydrug use, presents a complex and rapidly progressing emergency challenging to diagnose and manage. Early recognition of the sympathomimetic toxidrome and the immediate implementation of aggressive cooling measures are paramount. Emergency physicians must anticipate refractory dysrhythmias and rapid multiorgan failure to potentially improve outcomes.