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

摘要

Objective. — 4-Methyl-N-ethylcathinone (4-MEC) is a novel designer drug of the β-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—0.5 g 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 30min, 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 HPLC-UV/DAD, GC-MS, UPLC-MS/MS, and LC-HR-MS/MS were applied. Blood and urine levels (8 h after injection) were respectively 353 μg/L and 100mg/L for 4-MEC and 300mg/L and 1000 mg/L for