Nicol Jennifer J E, Yarema Mark C, Jones Graham R, Martz Walter, Purssell Roy A, MacDonald Judy C, Wishart Ian, Durigon Monica, Tzemis Despina, Buxton Jane A
Department of Emergency Medicine, University of Calgary, Calgary, Alta.
Department of Emergency Medicine, University of Calgary, Calgary, Alta. ; Poison and Drug Information Service, Alberta Health Services, Calgary, Alta.
CMAJ Open. 2015 Jan 13;3(1):E83-90. doi: 10.9778/cmajo.20140070. eCollection 2015 Jan-Mar.
Paramethoxymethamphetamine (PMMA) is a ring-substituted amphetamine similar in structure to 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"), but substantially more toxic. We describe the clinical features of fatal exposures in the provinces of Alberta and British Columbia, Canada.
We conducted a retrospective case series on deaths in Alberta and BC between June 2011 and April 2012 for which forensic toxicologic analysis was positive for PMMA and the drug was implicated as the primary toxic agent. Data collected included patient demographics, exposure history, clinical features, investigations, therapy provided and postmortem toxicologic findings.
A total of 27 PMMA-associated deaths (20 in Alberta, 7 in BC) were reported in the 11-month period. The median age was 24 (range 14-52) years, and 22 (81%) were male. Ten patients were pronounced dead at the scene, and 17 died in hospital. The median time from exposure to death was 17 (range 5-264) hours. The median first-recorded vital signs (and ranges) were: heart rate 160 (86-201) beats/min, blood pressure 89/43 (69/30-162/83) mm Hg, respiratory rate 40 (26-48) breaths/min, oxygen saturation 81% (68%-100%) and temperature 39.4°C (34-43.8°C). Sixteen of the 17 people who died in hospital presented with clinical features consistent with serotonin syndrome. End-organ dysfunction included hepatic (30%) and acute kidney injury (85%), rhabdomyolysis (54%), coagulopathy (61%) and cardiac ischemia (15%). Other drugs identified on toxicologic analysis were MDMA (n = 27), cocaine or its metabolite benzoylecgonine (n = 14) and methamphetamine (n = 12).
Exposure to PMMA was characterized by multiorgan dysfunction and serotonin syndrome, followed by cardiovascular collapse. In addition to PMMA, multiple synthetic amphetamines were present on toxicologic analysis. When evaluating patients suspected of exposure to sympathomimetic drugs of abuse, clinicians must anticipate multiple clinical effects from the increased release of dopamine, serotonin, norepinephrine and other neurotransmitters.
对甲氧基甲基苯丙胺（PMMA）是一种环取代苯丙胺，其结构与3,4-亚甲基二氧基甲基苯丙胺（MDMA，即“摇头丸”）相似，但毒性要大得多。我们描述了加拿大艾伯塔省和不列颠哥伦比亚省致命暴露的临床特征。
我们对2011年6月至2012年4月间艾伯塔省和不列颠哥伦比亚省的死亡病例进行了回顾性病例系列研究，这些病例的法医毒理学分析显示PMMA呈阳性，且该药物被认为是主要毒性物质。收集的数据包括患者人口统计学信息、暴露史、临床特征、检查、所提供的治疗以及尸检毒理学结果。
在这11个月期间，共报告了27例与PMMA相关的死亡病例（艾伯塔省20例，不列颠哥伦比亚省7例）。中位年龄为24岁（范围14 - 52岁），22例（81%）为男性。10例患者在现场被宣布死亡，17例在医院死亡。从暴露到死亡的中位时间为17小时（范围5 - 264小时）。首次记录的中位生命体征（及范围）为：心率160（86 - 201）次/分钟，血压89/43（69/30 - 162/83）毫米汞柱，呼吸频率40（26 - 48）次/分钟，血氧饱和度81%（68% - 100%），体温39.4°C（34 - 43.8°C）。在医院死亡的17人中，有16人表现出与血清素综合征一致的临床特征。终末器官功能障碍包括肝脏（30%）和急性肾损伤（
