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Case reports
Case 1: A 22-year-old man complained that he was "burning up" and collapsed after ingesting drugs at a friend's house. He died soon afterwards at a local hospital, despite attempts at resuscitation. His core temperature was 42oC. At autopsy there was evidence of coagulopathy, with scattered bruises, intra-alveolar haemorrhage, and haemorrhagic pleural effusions, ascites and stomach contents. Toxicological blood analysis revealed a lethal level of PMA (1.3 mg/L), together with 0.02 mg/L of MDMA and 0.21 mg/L of methylamphetamine. No alcohol was detected in the blood.
Case 2: An 18-year-old man died at his home after ingesting a number of "ecstasy" tablets over five hours, both at a dance club and at home. Two hours after death the core temperature of the body was 39oC. Autopsy revealed focal pericardial haemorrhage, pulmonary congestion and renal tubular necrosis. Toxicological blood analysis showed a lethal level of PMA (1.7 mg/L), with 0.1 mg/L of MDMA and 0.06 mg/L of methylamphetamine. No alcohol was detected in the blood.
Case 3: A 19-year-old man died in hospital 40 hours after being brought to the emergency department in respiratory arrest with a body core temperature of 41.6°C. He had taken "two or three capsules" of street drugs of an uncertain nature, both at a "rave" party and then at a friend's home the following day. According to witnesses, he had been advised to take PMA for an enhanced effect after taking MDMA. Laboratory investigations revealed evidence of rhabdomyolysis, with a serum myoglobin level of 328 960 g/L (normal level, < 150 g/L), disseminated intravascular coagulation and marked hyperkalaemia (7.7 mmol/L; normal range, 3.55.0 mmol/L).
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The Medical Journal of Australia 2002 ISSN: 0025-729X www.mja.com.au
http://www.mja.com.au/public/issues/176_10_200502/bya10720_fm.html
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