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Warrick BJ, Wilson J, Hedge M, Freeman S, Leonard K, Aaron C. 
“Lethal Serotonin Syndrome After Methylone and Butylone Ingestion”. 
J Med Toxicol. 2011 Dec 13.
INTRODUCTION: A new generation of designer phenethylamines have emerged and aggressively marketed as "legal highs." The drugs are labeled "not for human consumption" to avoid widespread recognition and prosecution under the existing analog drug laws. The newest generation includes methylone and butylone. Methylone and butylone have minor structural changes and similar pharmacodynamics properties to scheduled drugs.

CASE REPORT: We report a case of a healthy 24-year-old who ingested a capsule containing methylone and butylone sold as "Ecstasy" at a concert. The patient presented to the emergency department, comatose febrile, tachycardic, tachypnic, and hypertensive. On exam, she was diaphoretic, tremulous, hyperreflexic, and had sustained clonus. The patient was aggressively cooled, and despite maximal supportive care, the patient progressed to multi-system organ failure and ultimately expired. We obtained and analyzed both her urine and a capsule found on her person similar to the capsules ingested. In both samples, laboratory analysis identified only methylone and butylone.

CONCLUSIONS: This is the first reported death for methylone or butylone and the first human or animal ingestion of butylone. Clinicians and public health officials should work together as new designer drugs emerge.
Notes # : In the publisher's digital "Online First" version of this article [accessed Dec 22 2011], there actually is a discrepancy within the paper itself between the number of capsules ingested as described in the Abstract ("one") vs. the Discussion ("two").

The Discussion states: "Our patient died after ingesting two capsules despite expeditious treatment. Based on analytic evidence from a single capsule, we suspect she ingested 844 mg of methylone plus 106 mg of butylone. The dose the patient ingested was substantially over what has been reported as a 'normal' dose. However, we cannot confirm this dose since any illicitly marketed drug has substantial variability in purity and concentration."
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