INTRODUCTION: The pyrrolidinophenone-type designer drug 4'-methyl-alpha-pyrrolidinohexanophenone (MPHP) is presumed to be a potent psychostimulant as the structurally related drug pyrovalerone. This is the first report of an acute poisoning involving MPHP. CASE HISTORY: A 27 year old man was admitted to hospital in an agitated state and with fractures of both feet after jumping from a window. He had reportedly snorted a powder supposed to be cocaine on the previous day and taken amyl nitrite several days before. He presented with pronounced rhabdomyolysis and had to be treated by repeated hemodialysis. Elevated liver parameters indicated toxic liver damage. TOXICOLOGICAL ANALYSIS: The presumed cocaine powder was analyzed by gas chromatography-mass spectrometry (GC-MS) and high-performance liquid chromatography with diode array detection. The liquid and the urine samples were analyzed by headspace gas chromatography with flame ionization detection. Urine was submitted to enzymatic conjugate cleavage and further worked up by liquid-liquid extraction and acetylation or by mixed-mode solid-phase extraction (SPE) and trimethylsilylation. Serum was worked up by mixed-mode SPE. All extracts were analyzed by fullscan GC-MS. RESULTS: The powder and liquid were identified as MPHP and amyl nitrite, respectively. In the serum sample, MPHP was found in a concentration of approximately 100 ng/ml, while its 4'-carboxy metabolite was detected in urine. Amyl nitrite was not found in urine. CONCLUSION: The use of MPHP instead of cocaine is in line with its presumed stimulant properties. The presented data indicate that it can lead to serious poisoning with toxic liver damage and rhabdomyolysis.
INTRODUCTION: The pyrrolidinophenone-type designer drug 4'-methyl-alpha-pyrrolidinohexanophenone (MPHP) is presumed to be a potent psychostimulant as the structurally related drug pyrovalerone. This is the first report of an acute poisoning involving MPHP. CASE HISTORY: A 27 year old man was admitted to hospital in an agitated state and with fractures of both feet after jumping from a window. He had reportedly snorted a powder supposed to be cocaine on the previous day and taken amyl nitrite several days before. He presented with pronounced rhabdomyolysis and had to be treated by repeated hemodialysis. Elevated liver parameters indicated toxic liver damage. TOXICOLOGICAL ANALYSIS: The presumed cocaine powder was analyzed by gas chromatography-mass spectrometry (GC-MS) and high-performance liquid chromatography with diode array detection. The liquid and the urine samples were analyzed by headspace gas chromatography with flame ionization detection. Urine was submitted to enzymatic conjugate cleavage and further worked up by liquid-liquid extraction and acetylation or by mixed-mode solid-phase extraction (SPE) and trimethylsilylation. Serum was worked up by mixed-mode SPE. All extracts were analyzed by fullscan GC-MS. RESULTS: The powder and liquid were identified as MPHP and amyl nitrite, respectively. In the serum sample, MPHP was found in a concentration of approximately 100 ng/ml, while its 4'-carboxy metabolite was detected in urine. Amyl nitrite was not found in urine. CONCLUSION: The use of MPHP instead of cocaine is in line with its presumed stimulant properties. The presented data indicate that it can lead to serious poisoning with toxic liver damage and rhabdomyolysis.
Authors: Jorge Soares; Vera Marisa Costa; Maria de Lourdes Bastos; Félix Carvalho; João Paulo Capela Journal: Arch Toxicol Date: 2021-06-08 Impact factor: 5.153