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Wood DM, Davies S, Puchnarewicz M, Button J, Archer R, Ovaska H, Ramsey J, Lee T, Holt DW, Dargan PI. 
“Recreational Use of Mephedrone 4-Methylmethcathinone, 4-MMC with Associated Sympathomimetic Toxicity”. 
J Med Toxicol. 2010 Apr 1.
INTRODUCTION: Cathinone is a pharmacologically active alkaloid that can be extracted from the leaves of the khat plant Catha edulis. There are synthetic derivatives of cathinone entering the recreational drug market, including mephedrone 4-methylmethcathinone, 4-MMC. There are discrepancies in the legal status of both the khat plant and its extracted alkaloids between the UK and the USA. CASE REPORT: A 22-year-old man purchased 4 g of mephedrone powder over the Internet from a chemical supplier based in China. He initially ingested 200 mg of the mephedrone orally, with no perceived clinical effects, and thereafter injected the remaining 3.8 g intramuscularly into his thighs. Shortly after the injection, he developed palpitations, 'blurred tunnel vision,' chest pressure, and sweating and felt generally unwell he presented to hospital with continuing features of sympathomimetic toxicity. His symptoms settled over the next 4 h after a single dose of oral lorazepam. Qualitative analysis of the urine and serum sample was undertaken using gas chromatography with mass spectrometric GC/MS detection, both positive for the presence of 4-methylmethcathinone. Quantitative analysis of the serum sample was undertaken by liquid chromatography with tandem mass spectrometric detection the estimated mephedrone concentration was 0.15 mg/l. Routine toxicological analysis of the serum and urine specimens using a broad GC/MS toxicology screen did not detect any other drugs or alcohol.

PURPOSE: This is the first case of isolated 4-MMC toxicity, with confirmatory analytical findings. It is important that clinical toxicologists and emergency physicians work together to ensure a better understanding of the toxicity of novel/emerging drugs such as 4-MMC.
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