153. Recreational Use of 4-Methylmethcathinone (4-MMC) Presenting with Sympathomimetic Toxicity and Confirmed by Toxicological Screening
Wood DM,1,2 Davies S,3 Puchnarewicz M,3 Button J,3 Archer R,4 Ramsey J,3,5 Lee T,3 Holt DW,3 Dargan PI.1,2 1Clinical Toxicology, Guy’s and St Thomas’ Poisons Unit, London, United Kingdom; 2King’s Health Partners, London, United Kingdom; 3Analytical Unit, St George’s, University of London, London, United Kingdom; 4Kingston University, Kingston upon Thames, United Kingdom; 5TICTAC Communications, St George’s, University of London, London, United Kingdom.
Introduction: Leaves of the Khat plant (Catha Edulis) are widely chewed by the Somali community for their stimulant properties. This is due to release of cathinone from the leaves on chewing. Extraction from khat and/ or synthesis of cathinone and the related alkaloid methcathinone are controlled under the UK Misuse of Drugs Act, 1971. However, other cathinone derivatives such as 4-methylmethcathinone (4-MMC, mepherdone) are not currently controlled. 4-MMC is promoted as “safe and legal” alternative to classified recreational drugs. We report the first case of toxicity related to 4-MMC confirmed by toxicological screening. Case report: A 22 year old man presented after oral ingestion of 200mg and subcutaneous injection of 3.8g of 4- MMC. He developed palpitations and blurred vision shortly after use. On arrival in the ED he had sympathomimetic features (agitation, 7mm dilated pupils, HR 105, BP 177/111 mmHg). His temperature was 36.3°C and he had normal tone with no clonus. EKG showed a sinus tachycardia only. He was treated with 1mg of oral lorazepam. His sympathomimetic features settled within 6 hours of presentation. Serum and urine samples taken at the time of presentation were sent for toxicological analysis. Toxicological Screening Screening methods were developed for 4-MMC using in-house derivatives of cathinone and methcathinone checked for purity by Nuclear Magnetic Resonance. Samples were screened using Gas Chromatography with Mass Spectrometry. The only substance detected was 4-MMC; no other drugs or alcohol were detected. Liquid chromatography with tandem Mass Spectrometry was used to confirm and quantitate 4-MMC, the serum concentration was 0.15mg/L.
Conclusion: We report the first case of confirmed, lone, use of 4-MMC resulting in sympathomimetic toxicity. Clinical toxicologists should be aware of the potential for use of these compounds in patients presenting with sympathomimetic toxicity.