Among young people in Norway the recreational use of amphetamine derivatives seems to be increasing. Methylenedioxymethamphetamine (MDMA), known as ecstasy, is the dominant substance, having both stimulant and psychedelic properties. Depending on the illegal source of these so-called 'party drugs' the content and purity can vary. This case report describes the first lethal case of paramethoxyamphetamine (PMA) and paramethoxymethamphetamine (PMMA) intoxication reported in Norway. A 16-year-old male was admitted to a local hospital in a coma with seizures and hyperthermia after he had been found undressed and barefooted in a local forest (temperature 2 degrees C). He was intubated and given supportive care. Blood chemistry revealed hypoglycaemia, hypocalcaemia and hyperkalaemia. Shortly after transfer to the central hospital he developed bradycardia with continuous seizures and asystole. Adverse effects of MDMA are well described and include serotonergic and sympathomimetic symptoms with hyperthermia, coagulopathy, rhabdomyolysis and acute kidney and liver failure. Case reports of PMA deaths collectively suggest PMA to be more toxic than MDMA. A delayed effect after intake of PMA compared with MDMA can lead to increased intake. Hypoglycaemia and hyperkalaemia may be specific to PMA poisoning. Increased thermo genesis will result in a search for cooling, which explains the attempt to undress and a desire to submerge in water. In a cool climate this behaviour itself can be lethal. Measures to treat seizures, hypoglycaemia, electrolyte anomalies and hyperthermia are the therapeutic goals. No specific treatment is available.

Forty-two women at term received pethidine 100 mg and 43 received pentazocine 45 mg, both given in a double-blind randomized manner. There was no difference in analgesic effect between the groups, but twelve patients were judged to need more than one injection of pentazocine, compared with seven in the pethidine group. The Apgar scores at 1 and 5 min were significantly less in the pethidine group. Four neonates in the pethidine group and two in the pentazocine group were severely depressed and received naloxone between 5 and 15 min after birth. The remainder of the infants received naloxone 200 microgram i.m. 15 min after birth. From 5 min after birth, end-expiratory carbon dioxide concentrations and from 15 min transcutaneous PO2 were recorded. A significantly smaller end-tidal carbon dioxide concentration was measured when more than one injection of pentazocine had been given. Repeated doses of pethidine, on the other hand, resulted in a greater end-tidal carbon dioxide concentration. Vigorous ventilation was even more pronounced when naloxone was given indicating an analeptic effect when two drugs with antagonistic activity are combined. At no time was transcutaneous PO2 less than 6.1 kPa. We conclude that both pethidine and pentazocine produce adequate pain relief during labour, but more than one injection of pethidine is associated with greater neonatal depression.

A fatal case of propranolol intoxication is described. The patient had ingested 3-5 g of the drug and probably no other drugs. Gastric lavage could not be performed due to some kind of obstruction in the distal part of the oesophagus. At autopsy, the oesophagus was normal, and a spasm due to j3-blockade is suggested. Epileptiform seizures resistant to treatment with diazepam and barbiturates were frequent and probably not solely caused by cerebral ischaemia.

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Pulmonary oedema has been reported in severe cases of acetyl salicylic acid (ASA) poisoning. Liberal use of intravenous fluids, to establish a forced diuresis, is usually thought to be the precipitating cause. A case of severe ASA poisoning and respiratory failure was found to have increased pulmonary vascular resistance and signs of intravascular hypercoagulability. The patient recovered rapidly on mechanical ventilation with a positive endexpiratory pressure of 18 cm H2O and systemic steroids.