A multiple drug fatality involving MK-801 (dizocilpine),
a mimic of phencyclidine
Ashraf Mozayani*, Paul Schrode, Joye Carter, Terry J. Danielson
Office of the Chief Medical Examiner of Harris County, Joseph A. Jachimczyk Forensic Center,
1885 Old Spanish Trail, Houston, TX 77054, USA
Received 23 August 2002; received in revised form 25 November 2002; accepted 5 January 2003
Abstract
MK-801 (dizocilpine) is a non-competitive antagonist at the N-methyl-D
aspartate (NMDA) family of glutamate receptors in
the central nervous system. It is an anticonvulsant and also shares several
pharmacological properties with phencyclidine and
ketamine. It is not observed routinely as a substance of abuse. The
deceased, a 45-year-old white male, obtained MK-801
surreptitiously in an attempt to treat a self-diagnosed depression. He was
discovered the next morning, unresponsive on the
bathroom floor. An empty bottle, labeled to contain 25 mg of MK-801, was
found near the body.
The autopsy was performed at the Joseph A Jachimczyk Forensic Center,
Houston, TX. Body weight at autopsy was 88 kg.
Lungs were edematous and congested (right: 775 g; left 700 g). The heart
had proportionate chambers and was otherwise
unremarkable. The kidneys (right: 220 g; left 225 g) were smooth surfaced.
The brain (1550 g) was congested and without
trauma. Microscopic evaluation of the heart, kidneys and lungs showed
normal histology and confirmed pulmonary congestion
and edema. Samples of heart blood, liver, bile, vitreous humor, stomach
contents and urine were collected at autopsy. There were
550 ml of stomach contents.
Drugs in blood were screened by EMIT II Plus immunoassay procedures
and by gas chromatography/mass spectrometry (GC/
MS) of an organic solvent extract of basified blood. Alcohol was determined
by gas chromatography with headspace injection.
MK-801, benzodiazepines and alcohol were detected in blood.
Amounts of MK-801 present in blood, bile, liver, vitreous humor and urine
were 0.15, 0.29, 0.92, less than 0.1 and 0.36 mg/l
(kg), respectively.
The cause of death was benzodiazepine, dizocilpine and ethanol toxicity
and the manner accidental.
1. Introduction
MK-801 (dizocilpine) is a potent non-competitive antagonist
at the N-methyl-D-aspartate (NMDA) family of glutamate
receptors in the brain [1] and shares pharmacological
properties with phencyclidine and ketamine. MK-801 is
noted for its potency and ability to inhibit binding of ligands
to the PCP/sigma-receptor at concentrations below 1 ng/ml
[2].
In this manuscript, we report amounts of MK-801 in post-mortem tissues and urine from the first known death
associated with ingestion of this psychoactive substance.
The deceased, a 45-year-old male, was employed as a
gardener on family property and portrayed himself as a
‘‘researcher’’. He suffered from hypertension, hepatitis C
and an undiagnosed depression and had a history of marijuana
and heavy alcohol use. He had spoken of suicide on
two previous occasions. On the day prior to his death, he
verbally acknowledged receipt through the mail of ‘‘tricyclic
MK-801’’, which he had been seeking to cure his depression.
He was discovered the next morning, unresponsive on the
bathroom floor. One empty vial, labeled to originally contain
25 mg MK-801 maleate, was recovered near to the body.
The autopsy was performed at the Joseph A Jachimczyk
Forensic Center, Houston, TX. Body weight at autopsy was
88 kg. Lungs were edematous and congested (right: 775 g;
left: 700 g). The heart had proportionate chambers and was
otherwise unremarkable. The kidneys (right: 220 g; left:
225 g) were smooth surfaced. The brain (1550 g) was congested
and without trauma. Microscopic evaluation of the
heart, kidneys and lungs showed normal histology and
confirmed pulmonary congestion and edema. There was
550 ml of stomach contents.
Samples of heart blood, liver, bile, vitreous humor, stomach
contents and urine were collected at autopsy.....
.....Other non-prescribed drugs recovered at the scene
BTCP Dopamine uptake inhibitor [14]
U-50,488 s receptor ligand [15]
1-BCP AMPA receptor modulator [16]
Centrophenoxine Plant auxin, cerebral stimulant
5. Conclusion
This case is unique because of the variety of unusual
drugs and drug-like substances in the possession of the
deceased. Clearly, the apparent availability of these rare
drugs presents a challenge to the forensic toxicologist and
crime investigators....
