Poisoning with the recreational drug paramethoxyamphetamine ("death")

Objective: To describe the clinical features of paramethoxyamphetamine (PMA ; "death") poisoning and to compare these with those of people with self-re ported "ecstasy" poisoning. Design, Retrospective casenote review. Participants and setting: 22 patients who presented to the Emergency Depart ment of the Royal Adelaide Hospital (RAH), a major metropolitan teaching ho spital, between 1 January 1996 and 31 December 1998 with PMA poisoning iden tified through urine drug screens; and 61 patients with self-reported ecsta sy poisoning between 1 September 1997 and 31 December 1998 found through th e hospital databases. Results: Patients with PMA poisoning presented with tachycardia (64%), hype rthermia (temperature >37.5 degreesC; 36%), coma (41%), seizures (32%), arr hythmias (23%), and QRS intervals greater than or equal to 100 ms (50%) wit h greater frequency and often greater severity than those with self-reporte d ecstasy poisoning. Two patients with PMA poisoning presented with severe hypoglycaemia (blood glucose level, <1.5 mmol/L) accompanied by hyperkalaem ia (K+ concentration, >7.5 mmol/L). Conclusions: At our hospital, PMA poisonings accounted for most of the seve re reactions among people who believed they had taken ecstasy. Hypoglycaemi a and hyperkalaemia may be specific to PMA poisoning. PMA toxicity should b e suspected with severe or atypical reactions to "ecstasy", and confirmed b y chromatographic urine drug screens.