Acute combined poisoning with the new designer drug 4-methyl-N-ethyl-cathinone (4-MEC) and gammabutyrolactone (GBL): A case report with different analytical approaches for identification of some metabolites

Objective. 4-Methyl-N-ethylcathinone (4-MEC) is a novel designer drug of the p-keto amphetamine family. A case of a mixed poisoning by 4-MEC and gamma-butyrolactone (GBL) is described. Two and half hours after an injected 0.25-0.5g 4-MEC dose and thirty minutes after GBL ingestion, a 39-year-old man became unconscious and presented after admission to the hospital, transient apnea needing oxygenation and stimulation. After 30 min, he woke up, but remained confused for 4 hours. He was discharged 13 hours later without particular symptoms. For confirmation of the poisoning, different analytical procedures such as HPLCUV/DAD, GC-MS, UPLC-MS/MS, and LC-HR-MS/MS were applied. Blood and urine levels (8h after injection) were respectively 353 vig/L and 100 mg/L for 4-MEC and 300 mg/L and 1000 mg/L for gamma-hydroxybutyric acid. In urine, three metabolites (dihydro-, nor-, and nor-dihydro-4-MEC) could be identified for the first time and were similar to those described for other molecules of this class. (C) 2014 Societe Francaise de Toxicologie Analytique. Published by Elsevier Masson SAS. All rights reserved.