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

Abstract

Synthetic cathinones comprise a large amount of substances present on the dark market, which creates an undeniably worldwide problem and still is posing a threat. A 22‐year‐old man was brought to the Emergency Room from a party, where he had ingested orally 20 g of mephedrone. The man exhibited a disorder of consciousness with no logical verbal contact and dilated pupils. Moreover, a metabolic acidosis was present. The patient died after an hour from an admission to the ER. Blood and vitreous humor collected during an autopsy were analyzed with the use of an ultra‐high‐performance liquid chromatography‐tandem mass spectrometry (UHPLC‐QqQ‐MS/MS) with the use of C18 column in multiple reaction monitoring (MRM) mode. Both biological specimens were prepared using liquid–liquid extraction (LLE) with the use of ethyl acetate and 0.5 M ammonium carbonate water solution (pH 9). The limit of quantification (LOQ) of the method was 0.5 ng/ml in both matrices; precision and accuracy values did not exceed ±15%. Recovery of the method was in the range of 86.1%–102.7%. Determined concentrations of 4‐CMC were 8542 and 9874 ng/ml in blood and vitreous humor, respectively. Other substances present in both biological materials were: atropine, diazepam, lidocaine, and its metabolite norlidocaine, as well as methcathinone and ethyl alcohol. The concentration presented in here described case is the highest ever reported 4‐CMC concentration. Important aspect is also receiving other NPS by recreational users than intended, which lead to accidental poisoning (in presented case user assumed 4‐CMC was 4‐MMC).

Interpretative problems due to the presence of chloromethcathinone isomers in the biological material from postmortem cases

“…The work of Tusiewicz et al. ( 19 ) described the highest concentration of 4-CMC to the present moment. A 22-year-old man was taken to the emergency room (ER) from a party, where, according to a witness’ statement: “1.5 hours before he had ingested orally 20 grams of mephedrone”.…”

Toxicity of the New Psychoactive Substance (NPS) Clephedrone (4-Chloromethcathinone, 4-CMC): Prediction of Toxicity Using In Silico Methods for Clinical and Forensic Purposes

“…The only reports available are related to incidents involving this substance, though often, it is not the only substance implicated [ 4 ]. The highest reported concentration of 4-CMC in the blood and vitreous humor were, respectively, 8542 and 9874 ng/mL [ 22 ].…”

3-CMC, 4-CMC, and 4-BMC Human Metabolic Profiling: New Major Pathways to Document Consumption of Methcathinone Analogues?

“…Further studies are necessary to understand the differences in their pharmaco-toxicological profiles (4,(6)(7)(8). However, despite the health risks associated with their consumption, SCs have gained great popularity and several intoxications and fatalities related to halogenated SCs have been recently reported (1,6,(9)(10)(11)(12)(13)(14)(15). Particularly, many cases involved 4-CMC consumption along with other NPSs.…”