Lethal amphetamine intoxication

Abstract

Three cases of lethal amphetamine intoxication are reported. The autopsy findings included pulmonary hemorrhage as well as subendocardial and gastric mueosal hemorrhages. The following tissue concentrations of amphetamine were found: 0.05--0.7 mg per 100 ml blood, 1 . 2 4 . 5 mg per 100 g liver and 0.4--0.8 mg per 100 g kidney. The pathological and toxicological findings are discussed with respect to previously published cases of metamphetamine poisoning as well as fatal intoxications due to combinations of amphetamine and other drugs.Zusammen/assung. Pathologiseh-anatomische und toxikologische Befunde yon drei Fallen yon tSdlicher Amphetaminvergiftung werden besehrieben. Subpleurale und subendoeardielle Blutungen sowie Blutungen im Lungenparenchym wurden beobachtet. Die Konzentrationen des Amphetamins betrugen ca. 0,05~0,7 mg per 100 ml Blur, 1,2-4,5 mg per 100 g Leber, 0,4--0,8 mg per 100 g Niere, und in einem Fall ca. 70 mg per 100 ml Ham. Weder Alkohol noch Arzneimittel konnten nachgewiesen werden.The intravenous injection of centrally stimulating amines ("Weck-amines ") can assume epidemic characteristics. This was first reported from J a p a n (Nagahama, 1968), but has since t h e n been experienced in several other countries among t h e m Sweden (Goldberg, 1968;Inghe, 1969). I n this country the abuse of psychoactive drugs, p r i m a r i l y phcnmetrazine, a m p h e t a m i n e and m e t a m p h e t a m i n e , often administered intravenously dissolved in t a p water, has been increasing since the 1940-ies and developed into a considerable social and medical problem.A m p h e t a m i n e , fl-phenylisopropylamine, is a s y m p a t h o m i m e t i c amine with a multitude of pharmacological effects involving p r i m a r i l y the central nervous and circulatory systems. I n high doses it produces a sustained rise in blood pressure and an increased heart rate. Arrythmias, extensive sweating and increase in b o d y t e m p e r a t u r e are further effects of larger t h a n therapeutic doses of amphetamine. Serious cases progress to convulsions, coma, circulatory collapse and death. D e a t h caused b y a m p h e t a m i n e intoxication has been ascribed to cardiovascular collapse, h y p e r p y r e x i a or cerebral hemorrhage (Davis et al., 1968).There are several problems facing the forensic scientists in evaluating the cause of death occurring in connection with the abuse of a m p h e t a m i n e drugs.

Sympathomimetic amine compounds and hepatotoxicity: Not all are alike—Key distinctions noted in a short review

“…While hyperthermia is a well-known symptom experienced after administration of amphetamines and in cases of intoxication [[12], [13], [14], [15], [16], [17], [18]], these effects have not been noted for various compounds such as tuaminoheptane, ephedrine, 1,3-dimethylamylamine, pseudoephedrine, oxymetazoline and phenylephrine [[19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]]. Rather, adverse effects seem confined to neurological and cardiovascular systems.…”

Review article: mechanisms and management of hepatotoxicity in ecstasy (MDMA) and amphetamine intoxications

“… 19 Unfortunately 5–9% of Caucasians lack this cytochrome as a result of an autosomal recessive inheritance of gene mutations, and they have a propensity to develop exaggerated pharmacological responses due to impaired metabolism of the parent drug 19 –21 . This may be one of the reasons that accounts for the fact that whilst many ‘ravers’ take ecstasy, only a tiny proportion appear to develop clinical hepatotoxicity, as differences in tolerance to the drug have been reported 22 . However, immunological mechanisms may be more important in determining susceptibility to damage.…”

Tissue Distribution of Amphetamine Isomers in a Fatal Overdose

“…Mass spectrum of the peak (amphetamine-HFB) is shown in the inset, The concentration is given in Table I. higher are not uncommon in severe addicts with high tolerance. This wide range of fatal concentrations is also observed in urine and liver (ranging from 39 to 700 pg/mL and from 0.7 to 45 pg/g, respectively) (11)(12)(13). Reported kidney concentrations range from 4 to 8 pg/g (12).…”

“…Our quantitative values were compared with three original references from 1970 to 1975 (11)(12)(13). No recent data on amphetamine overdose were available.…”