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A case of extreme agitation and death after the use of mephedrone in The Netherlands

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Abstract

A 36-year old man, having injured himself severely by smashing windows in a rage of fury, was arrested by the police. He died despite resuscitation attempts. The forensic autopsy showed many superficial skin lacerations, bruises and minor brain swelling, but there was no definitive cause of death. Toxicological analysis showed a high concentration of mephedrone in femoral blood (5.1 mg/L) and traces of cocaine, MDMA and oxazepam. The remaining dose of mephedrone in the stomach contents was estimated at 113 mg. Tablets that were found in the house of the deceased also contained mephedrone. We attribute this man's death to a fatal oral intake of mephedrone, which probably led to a state of excited delirium. This was aggravated by blood loss from multiple wounds.

Introduction

A 36-year old man was arrested by the police after he had injured himself severely by smashing windows, in a rage of fury. He was naked and covered in blood. Shortly after the intravenous administration of midazolam and naloxone by medical personnel, the man lost consciousness. Epinephrine and atropine were administered in an unsuccessful attempt to resuscitate the man. During the external examination by the medical examiner, a blood sample was drawn from the jugular vein. Other fluids and tissue samples were obtained at autopsy. The autopsy and toxicological analyses were performed at the Netherlands Forensic Institute. 96 green tablets and a white powder were found in the house of the deceased. The green tablets had a captagon logo on one side (Fig. 1a) and a circled R with a line on the other (Fig. 1b).

Section snippets

Materials

Certified reference mephedrone ((±)-4′-methylmethcathinone.HCl) was obtained from the Australian Government National Measurement Institute (Pymble, Sydney, New South Wales, Australia). Oxazepam-D5 (100 μg/mL in methanol) was obtained from Cerilliant. All other chemicals were analytical grade.

Samples

The post-mortem samples (heart blood, femoral blood, urine, vitreous humour, bile, gastric contents, small intestine contents, brain and liver) were obtained by the pathologist at the autopsy at the NFI and

Autopsy results

During autopsy, many wounds (haemorrhages, bruises, scratches and cuts), mostly superficial, were observed. Several superficial veins and a tendon of the hand were cut. The cuts could be explained by the smashing of windows. The internal examination of the body did not reveal any organ abnormalities that would explain death. Minor brain swelling and lung oedema were observed. The pale colour of the internal organs and post-mortem lividity indicated that the blood loss from the cuts must have

Discussion

The presence of cocaine and its metabolites (benzoylecgonine, methylecgonine), MDMA, oxazepam and midazolam in the blood of the deceased confirm the use or administration of these substances. Midazolam was given by medical personnel. The concentrations of oxazepam and midazolam are too low to significantly contribute to the man's death [6]. The presence of metanephrine (a metabolite of epinephrine) and atropine is explained by the administration of epinephrine and atropine during resuscitation.

Disclosure statement

Ann Maes performed the autopsy in this case. Klaas Lusthof, Roelof Oosting and Miranda Verschraagen did the planning and evaluation of the toxicological investigations, Albert Dijkhuizen did the mephedrone analysis, and Annette Sprong did the investigations on the tablets and powder. All authors have approved the final article. There are no actual or potential conflicts of interest for any of the authors.

References (21)

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