Skip to main content
SpringerLink
Log in

Acute methoxetamine and amphetamine poisoning with fatal outcome: A case report

  • Case Report
  • Published:
International Journal of Occupational Medicine and Environmental Health

Abstract

Methoxetamine (MXE) is a psychoactive substance distributed mostly via the Internet and is not liable to legal regulation in Poland. MXE has a toxicity profile similar to that of ketamine but longer-lasting effects. The paper describes a case of acute poisoning that resulted from recreational use of MXE and amphetamine and ended in death. In mid-July 2012, a 31-year old man was admitted to the clinical toxicology unit in Gdańsk because of poisoning with an unknown psychoactive substance. The patient was transported to the emergency department (ED) at 5:15 a.m. in a very poor general condition, in a deep coma, with acute respiratory failure, hyperthermia (> 39°C) and generalized seizures. Laboratory tests showed marked leukocytosis, signs of massive rhabdomyolysis, hepatic failure and beginning of acute renal failure. Despite intensive therapy, the patient died 4 weeks after the poisoning in the course of multi-organ dysfunction syndrome. Chemical and toxicological studies of serum and urine samples collected on the poisoning day at 1:40 p.m. confirmed that amphetamine and MXE had been taken earlier that day. Concentration of amphetamine in the serum (0.06 μg/ml) was within the non-toxic range, while MXE (0.32 μg/ml) was within the toxic range of concentrations. Amphetamine was also detected in the patient’s hair, which suggested a possibility of its use within the last dozen weeks or so. The serious clinical course of intoxication and co-existence of amphetamine and MXE in the patient’s blood and urine suggest the possibility of adverse interactions between them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Skowronek R, Celiński R, Chowaniec C, Skowronek A. [Ketamine and methoxetamine — old medicine and its new narcotic derivative]. Alkohol Narkom. 2012;25(3):317–326. Polish.

    Google Scholar 

  2. Hofer KE, Grager B, Müller DM, Rauber-Lüthy C, Kupferschmidt H, Rentsch KM, et al. Ketamine-like effects after recreational use of methoxetamine. Ann Emerg Med. 2012;60(1):97–99, http://dx.doi.org/10.1016/j.annemergmed.2011.11.018.

    Article  PubMed  Google Scholar 

  3. Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone to-morrow… and back again? A review of herbal marijuana alternatives (K2, spice), synthetic cathinones (bath salts), kratom, salvia divinorum, methoxetamine, and piperazines. J Med Toxicol. 2012;8:15–32, http://dx.doi.org/10.1007/s13181-011-0202-2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Kintz P, Cirimele V, Tracqui A, Mangin P. Simultaneous determination of amphetamine, methamphetamine, 3,4-methylenodioxyamphetamine and 3,4-methylenodioxymethamphetamine in human hair by gas chromatography-mass spectrometry. J Chromatogr B. 1995;670:162–166, http://dx.doi.org/10.1016/0378-4347(95)00160-K.

    Article  CAS  Google Scholar 

  5. Roth BL, Gibbons S, Arunotayanun W, Huang Xi-Ping, Setola V, Treble R, et al. The ketamine analogue methoxetamine and 3- and 4-methoxy analogues of phencyclidine are high affinity and selective ligands for the glutamate NMDA receptor. PLoS ONE. 2013;8(3):e59334, http://dx.doi.org/10.1371/journal.pone.0059334.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Coppola M, Mondola R. Methoxetamine: From drug of abuse to rapid-acting antidepressant. Med Hypotheses. 2012;79:504–507, http://dx.doi.org/10.1016/j.mehy.2012.07.002.

    Article  CAS  PubMed  Google Scholar 

  7. Corazza O, Schifano F, Simonato P, Fergus S, Assi S, Stair J, et al. Phenomenon of new drugs on the Internet: The case of ketamine derivative methoxetamine. Hum Psychopharmacol Clin Exp. 2012;27:145–149, http://dx.doi.org/10.1002/hup.1242.

    Article  CAS  Google Scholar 

  8. Corazza O, Assi S, Schifano F. From “Special K” to “Special M”: The evolution of the recreational use of ketamine and methoxetamine. CNS Neurosci Ther. 2013;19:454–460, http://dx.doi.org/10.1111/cns.12063.

    Article  CAS  PubMed  Google Scholar 

  9. Hill SL, Harbon SCD, Coulson J, Cooper GA, Jackson G, Lupton DJ, et al. Methoxetamine toxicity reported to the National Poisons Information Service: Clinical characteristics and patterns of enquiries (including the period of the introduction of the UK’s first Temporary Class Drug Order). Emerg Med J. 2014;31(1):45–47, http://dx.doi.org/10.1136/emermed-2012-202251.

    Article  PubMed  Google Scholar 

  10. Wood DM, Davies S, Puchnarewicz M, Johnston A, Dargan PI. Acute toxicity associated with the recreational use of the ketamine derivative methoxetamine. Eur J Clin Pharmacol. 2012,68:853–856, http://dx.doi.org/10.1007/s00228-011-1199-9.

    Article  CAS  PubMed  Google Scholar 

  11. Shields JE, Dargan PI, Wood DM, Puchnarewicz M, Davies S, Waring WS. Methoxetamine associated reversible cerebellar toxicity: Three cases with analytical confirmation. Clin Toxicol. 2012;50(5):438–440, http://dx.doi.org/10.3109/15563650.2012.683437.

    Article  CAS  Google Scholar 

  12. Wikstrom M, Thelander G, Dahlgren M, Kronstrand R. An accidental fatal intoxication with methoxetamine. J Anal Toxicol. 2013;37:43–46, http://dx.doi.org/10.1093/jat/bks086.

    Article  PubMed  Google Scholar 

  13. Paoli GD, Brandt SD, Wallach J, Archer RP, Pounder DJ. From the street to the laboratory: Analytical profiles of methoxetamine, 3-methoxyeticyclidine and 3-methoxyphencyclidine and their determination in three biological matrices. J Anal Toxicol. 2013;37:277–283, http://dx.doi.org/10.1093/jat/bkt023.

    Article  PubMed  Google Scholar 

  14. Moffat AC, Osselton MD, Widdop B, Watts J. Clarke’s analysis of drugs and poisons. 4th ed. London: Pharmaceutical Press; 2011.

    Google Scholar 

  15. Röhrich J, Kauret G. Determination of amphetamine and methylenodioxy-amphetamine-derivatives in hair. Forensic Sci Int. 1997;84:179–188, http://dx.doi.org/10.1016/S0379-0738(96)02061-0.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Forensic Medicine, Medical University of Gdansk, Gdańsk, Poland

    Marek Wiergowski, Maciej Krzyżanowski & Zbigniew Jankowski

  2. Department of Clinical Toxicology, Medical University of Gdansk, Gdańsk, Poland

    Jacek Sein Anand

  3. Pomeranian Center of Toxicology, Gdańsk, Poland

    Jacek Sein Anand

  4. Department of Forensic Medicine, Medical University of Gdansk, Dębowa 23, 80-204, Gdańsk, Poland

    Marek Wiergowski

Authors
  1. Marek Wiergowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacek Sein Anand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maciej Krzyżanowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zbigniew Jankowski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marek Wiergowski.

Additional information

Government-funded research (ST-33) by the Medical University of Gdańsk. Manager of the project: Zbigniew Jankowski, habilitated doctor.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wiergowski, M., Anand, J.S., Krzyżanowski, M. et al. Acute methoxetamine and amphetamine poisoning with fatal outcome: A case report. IJOMEH 27, 683–690 (2014). https://doi.org/10.2478/s13382-014-0290-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2478/s13382-014-0290-8

Key words

Search

Navigation