The rise in popularity of "bath salts" as safe alternatives to MDMA, methamphetamine, and other illicit substances has resulted in increased scrutiny of the contents and toxicology associated with these products. We report a case of sudden death related to the synthetic cathinone methylone in a previously healthy 19-year-old man. While several fatal case reports have been published involving methylone and other synthetic cathinones, this is the first reported case of sudden cardiac death associated with methylone use. Our report suggests that methylone toxicity has been greatly underestimated by users of this synthetic cathinone. Toxicology analysis was performed on the decedent's urine and central blood. Drugs-of-abuse immunoassays were performed to screen for amines, cocaine, tetrahydrocannabinol, phencyclidine, barbiturates, 3,4-methylenedioxy-N-methylamphetamine (MDMA), oxycodone, benzodiazepines, 6-acetylmorphine, and opiates. Qualitative analysis was performed on the decedent's urine for forensic volatiles by gas chromatography/mass spectrometry with a full scan detection method. Identification of known and unknown compounds was then accomplished by referencing the American Academy of Forensic Science library and the Armed Forces Medical Examiner System library. Derivatized methylone was further analyzed from urine and central blood using GC-MS in a selected ion monitoring (SIM) mode. A standard curve, a positive control, and the blood and urine for this case were analyzed, which provided quantitative analysis. Methylone was initially detected in the urine, and quantitative analysis revealed a blood concentration of 0.07 mg/dL. No other drugs were detected in the urine or central blood. To our knowledge, our report is the first documented case of sudden death following methylone use. Given that the postmortem blood concentration of methylone was lower than that reported in MDMA deaths, our case suggests the possibility that methylone toxicity has been greatly underestimated. It is important that the potentially severe toxicity of synthetic cathinones be recognized. More diligent reporting of bath salt cases may increase public awareness of the dangers involved with the use of this class of drugs. Furthermore, toxicology screening and reference libraries will require thorough investigation and updating as the number of novel synthetic cathinones continues to grow. Category:Chemistry
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