Abstract

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 3,4-methylenedioxymethamphetamine (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 postmortem context. The authors report an intoxication case with MDMA, in an 18-year-old male, considered a potential organ donor after a cardiac arrest. Whole blood samples were collected in vivo, at the emergency room (ER), and postmortem, at the National Institute of Legal Medicine and Forensic Sciences. After a general screening procedure, samples were extracted by solid phase extraction (OASIS^® MCX), followed by gas chromatography–mass spectrometry analysis. The whole blood postmortem sample was positive for lidocaine (<500 ng/mL), compatible with the ER intervention, and positive for MDMA (2278 ng/mL) and methylenedioxyamphetamine (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 (504–1918 ng/mL) and MDA (20–89 ng/mL). Samples were negative for other substances, namely ethanol, other drugs of abuse and medicines. Results interpretation is pivotal to understand the behavior of the substance. Thus, in this case, MDMA postmortem behavior 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 antemortem/postmortem 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.

中文翻译：

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潜在心脏衰竭的供体中的MDMA中毒。

摘要

苯丙胺及其衍生物的消费仍然是重要的公共卫生问题，即就化合物的可变性和对消费者的处置而言。但是，其中有些像3,4-亚甲二氧基甲基苯丙胺（MDMA）仍然存在于非法市场中，并取得了持续的成功。然而，在体内和死后情况下，总是有关于MDMA中毒的新信息和数据。作者报告了一名18岁男性的MDMA中毒案例，该男性被认为是心脏骤停后的潜在器官供体。在国家法律医学和法医学研究所的急诊室（ER）进行活体全血采集并进行死后采集。经过常规筛选程序后，样品通过固相萃取（OASIS^® MCX），然后用气相色谱-质谱分析。验尸后的全血样本利多卡因阳性（<500 ng / mL），与ER干预相符，MDMA（2278 ng / mL）和亚甲二氧基苯丙胺（MDA）（49 ng / mL）呈阳性，同时采集全血样本体内（在维持高生命的个体维持生命期间）的MDMA（504–1918 ng / mL）和MDA（20–89 ng / mL）呈阳性。样品中的其他物质（例如乙醇），其他滥用药物和药物均为阴性。结果解释对于了解物质的行为至关重要。因此，在这种情况下，应仔细评估MDMA的事后行为，并在可能的情况下，在具体情况下，考虑死亡验证，维持高级生命支持和出于器官收集目的的身体操纵之间的时间间隔。还参考和讨论了MDMA获得值的事前/事后比率，并与文献参考进行了比较。毫无疑问，死亡是由于MDMA中毒引起的，但有关体内样品表明，应尽可能补充考虑这种类型的样品。