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- MDMA intoxication in a potential organ donor with cardiac arrestPublication . Castro, André Lobo; Tarelho, Sónia; Almeida, Dina; Sousa, Lara; Franco, João; Teixeira, Helena M.Amphetamine and its derivatives’ consumption is still an important public health issue, namely in terms of compounds variability and disposition to consumers. However, some of them, like MDMA, still live in the illicit market, with continuous success. Nevertheless, there is always new information and data on MDMA intoxication, both in vivo and in post-mortem context. The authors report an intoxication case with MDMA, in an 18 years old male, considered a potential organ donor after a cardiac arrest. Whole blood samples were collected in vivo, at the Emergency Room (ER), and post-mortem, at the National Institute of Legal Medicine and Forensic Sciences. After a general screening procedure, samples were extracted by SPE (OASIS® MCX), followed by GC-MS analysis. The whole blood post-mortem sample was positive for lidocaine (< 500 ng/mL), compatible with the ER intervention, and positive for MDMA (2278 ng/mL) and MDA (49 ng/mL), while whole blood samples collected in vivo (during the maintenance of the individual under advanced life support), were positive for MDMA (504 ng/mL to 1918 ng/mL) and MDA (20 ng/mL to 89 ng/mL). Samples were negative for other substances, namely ethanol, other drugs of abuse and medicines.Results interpretation is pivotal to understand the behaviour of the substance. Thus, in this case, MDMA post-mortem behaviour should be carefully evaluated, considering as possible influencers, in the specific context of the case, the time lapse between death verification, maintenance of the advanced life support and body manipulation for organ collection purposes. Also referred and discussed is the ante-mortem/post-mortem ratio of MDMA obtained values, compared with literature references. There is no doubt that death was due to MDMA intoxication, but information from the analysis performed on the in vivo samples suggests that this type of sample should also be considered, in a complementary role, whenever possible.
- Intoxication by 3-MeO-PCP and O-desmethyltramadol: an unusual NPS mixPublication . Castro, André Lobo; Carneiro De Sousa Pinto Costa, Maria José; Tarelho, Sónia; Sousa, Lara; Russo, Fernando; Franco, João MiguelOver the past few years, the new psychoactive substances’ phenomenon has been continuously studied. Its dynamic context is characterized by a broad diversity of substances, including several groups, such as synthetic cathinones, synthetic opiates, and synthetic cannabinoids. However, and due both to this diversity and to the low number of detected cases, information on intoxication reports is always important, in order to understand their biological mechanisms. In this case, a male individual was found unresponsive, with some different powders and paraphernalia near him. After toxicological analysis to the powders, paraphernalia, and whole blood samples, five different compounds were identified. From these, two of them (3-MeO-PCP and o-desmethyltramadol) were identified and quantitated in the whole blood sample. The obtained results suggested that death was due to the presence and action of these two substances, in what may be considered an unusual mix of NPS. This case highlights the value of evaluating all the traces found in the scene investigation and the need of sending all the paraphernalia found for toxicological examination, together with all the possible information obtained on the scene, namely by relatives or witnesses. On the other hand, this case shows the significance of broad-spectrum analytical methods, in order to detect and identify, as specifically as possible, eventual substances present and used by victims.