Fatal intoxication with N-ethylpentylone: a case report

Abstract

Synthetic cathinones represent the latest genre of new drugs of abuse, which are increasing in popularity in part because they are readily available and because they are not detected by routine drug testing. They provide a cheaper substitute to stimulants such as methamphetamine and cocaine and are sold on the internet and in retail establishments as ‘bath salts,’ ‘plant food,’ or ‘research chemicals.’ We report a case involving a 21-year-old male who suffered arrest-related death due to intoxication with N-ethylpentylone, a new cathinone derivative. He reportedly left his house to smoke marijuana and returned displaying extremely odd behavior. The patient was unresponsive upon presentation to the emergency room and was intubated after suffering cardiac arrest. Clinical laboratory values revealed elevated lactic acidosis, hyperkalemia, rhabdomyolysis, and renal injury. His condition continued to worsen despite medical management. Sudden cardiac arrest occurred again 72 hours into his hospital stay and the patient was pronounced dead. Post-mortem toxicology testing with gas chromatography and mass spectrometry determined the presence of N-ethylpentylone in the urine. This case report details the behavior effects, clinical presentation, and autopsy findings for N-ethylpentylone drug intoxication.

Synthetic Cathinones and Neurotoxicity Risks: A Systematic Review

“…In the cases reported here, SCs were detected and quantified in post-mortem biological samples (n = 8), except for two cases. In the first of these, tests for SC metabolites and for 25INBOMe (5-HTA2 receptor agonist) were negative at hospital admission, while post-mortem GC and MS analyses revealed N-ethylpentylone in the urine [ 110 ]; in the second case, routine drug screening was performed post-mortem showing N-Ethylpentylone [ 111 ].…”

A review of synthetic cathinones emerging in recent years (2019–2022)

“…in fatal intoxication cases [ng/mL or g] Conc. in non-fatal intoxication cases [ng/mL] Reported intoxication symptoms N- Ethylhexedrone 2-(Ethylamino)-1-phenylhexan-1-one 50–60 Blood: 4–285 Urine: 147–1477 Bile: 34 Lung Brain: 5 [ 97 , 127 , 129 – 133 ] Blood: 1–84 Urine: 165 [ 100 , 127 , 134 – 136 ] Euphoria, stimulation, hyperthermia, tachycardia, vasoconstriction, aggression, dilatated pupils, anxiety, hallucinations, paranoia, acute kidney failure, insomnia, convulsions Ephylone 1-(1,3-Benzodioxol-5-yl)-2-(ethylamino)-pentan-1-one 10–100 Blood: 1–50,000 Urine: 18,000 [ 9 , 58 – 62 , 133 , 143 – 146 ] Blood: 7–149 Urine: 2000–10,700 Oral fluid: 13–1380 [ 58 , 143 , 147 , 148 ] Euphoria, stimulation, tachycardia, hyperthermia, palpitations, delusional state, aggression, psychosis, paranoia, hallucinations, confusion, sleeplessness, cardiac arrest, dissociative effects, acidosis, mydriasis rhabdomyolysis, renal failure Eutylone 1-(1,3-Benzodioxol-5-yl)-2-(ethylamino)-butan-1-one 50–200 Blood: 1–11,000 Urine: 192,000 Gastric content: 2120 Fat tissue: 1310 [ 65 , 67 , 150 ] Blood: 1–3600 Urine: 54–18,400 [ 65 , 67 , 151 – 154 ] ...…”

“…Additionally, studies in zebrafish showed its neurotoxicity, cardiotoxicity and developmental toxicity [ 142 ]. There are reports of deaths with ephylone detected in biological material [ 9 , 58 – 62 , 133 , 143 – 146 ], as well as cases of non-fatal poisoning [ 58 , 143 , 147 , 148 ]. The blood concentrations of ephylone detected in these cases were 1–50,000 ng/mL and 7–149 ng/mL, respectively (Table 1 ).…”

Behavioural and neurochemical effects after repeated administration of N‐ethylpentylone (ephylone) in mice

“…Consequently, when pentylone was scheduled (DEA, 2014), new beta‐keto‐methylenedioxyamphetamines, such as N‐ethyl‐pentylone (NEP, also known as ephylone and N‐ethylnorpentylone), broke into the illicit market. In fact, some fatalities and acute intoxications after NEP consumption have been recently reported (Blanco et al, 2021; Costa et al, 2019; Ikeji et al, 2018; Krotulski et al, 2018; Thirakul et al, 2017). In 2017 and 2018, NEP was the most commonly reported synthetic cathinone, accounting for approximately 50% of identifications (Drug Enforcement Administration (DEA) 2018).…”

“…talities and acute intoxications after NEP consumption have been recently reported (Blanco et al, 2021;Costa et al, 2019;Ikeji et al, 2018;Krotulski et al, 2018;Thirakul et al, 2017). In 2017 and 2018, NEP was the most commonly reported synthetic cathinone, accounting for approximately 50% of identifications (Drug Enforcement Administration (DEA) 2018).…”