Login | Register

A case of fatal idiosyncratic reaction to the designer drug 3,4-methylenedioxypyrovalerone (MDPV) and review of the literature


A case of fatal idiosyncratic reaction to the designer drug 3,4-methylenedioxypyrovalerone (MDPV) and review of the literature

Desharnais, Brigitte ORCID: https://orcid.org/0000-0001-7373-656X, Dazé, Yann, Huppertz, Laura M., Mireault, Pascal and Skinner, Cameron D. (2017) A case of fatal idiosyncratic reaction to the designer drug 3,4-methylenedioxypyrovalerone (MDPV) and review of the literature. Forensic Science, Medicine and Pathology, 13 . pp. 350-354. ISSN 1547-769X

[thumbnail of Post-print: final draft post-refeering]
Text (Post-print: final draft post-refeering) (application/pdf)
MDPV_Case_Report.pdf - Accepted Version
Available under License Spectrum Terms of Access.

Official URL: https://doi.org/10.1007/s12024-017-9894-1


The stimulant designer drug 3,4-methylenedioxypyrovalerone (MDPV) was first synthesized by Boehringer Ingelheim in 1969 and introduced on the black market in 2006. Only a small number of fatal intoxication cases have been reported in the literature, all with significant blood MDPV concentrations. In this report, we describe one fatality attributed to an idiosyncratic reaction to MDPV. The victim displayed agitation, violent behavior and delirium followed by cardiac arrest. Hyperthermia was observed at the hospital. The MDPV cardiac and femoral blood concentrations were 6 ng/mL. The presence of excited delirium syndrome and MDPV, a drug with a pharmacology similar to cocaine, leads to the conclusion that the victim suffered a fatal adverse reaction to MDPV. This is the first published case of idiosyncratic reaction to MDPV.

Divisions:Concordia University > Faculty of Arts and Science > Chemistry and Biochemistry
Item Type:Article
Authors:Desharnais, Brigitte and Dazé, Yann and Huppertz, Laura M. and Mireault, Pascal and Skinner, Cameron D.
Journal or Publication:Forensic Science, Medicine and Pathology
Date:1 July 2017
  • Laboratoire de sciences judiciaires et de médecine légale
  • National Sciences and Engineering Research Council of Canada
  • Fonds de recherche du Québec - Nature et technologies
Digital Object Identifier (DOI):10.1007/s12024-017-9894-1
Keywords:MDPV, “bath salts”, Idiosyncratic reaction, Toxicology, Excited delirium, Adverse drug reaction
ID Code:986236
Deposited On:15 Jan 2020 20:45
Last Modified:15 Jan 2020 20:50
Related URLs:
Additional Information:This is a post-peer-review, pre-copyedit version of an article published in Forensic Science, Medicine and Pathology. The final authenticated version is available online at: https://doi.org/10.1007/s12024-017-9894-1


1.Coppola M, Mondola R. 3,4-Methylenedioxypyrovalerone (MDPV): chemistry, pharmacology and toxicology of a new designer drug of abuse marketed online. Toxicol Lett. 2012;208:12–5.

2.Strano-Rossi S, Cadwallader AB, de la Torre X, Botrè F. Toxicological determination and in vitro metabolism of the designer drug methylenedioxypyrovalerone (MPDV) by gas chromatography/mass spectrometry and liquid chromatography/quadrupole time-of-flight mass spectrometry. Rapid Commun Mass Spectrom. 2010;24:2706–14.

3.Murray BL, Murphy CM, Beuhler MC. Death following recreational use of designer drug “bath salts” containing 3,4-Methylenedioxypyrovalerone (MDPV). J Med Toxicol. 2012;8:69–75.

4.Borek HA, Holstege CP. Hyperthermia and multiorgan failure after abuse of “bath salts” containing 3,4-Methylenedioxypyrovalerone. Ann Emerg Med. 2012;60:103–5.

5.Zawilska JB, Wojcieszak J. Designer cathinones—an emerging class of novel recreational drugs. Forensic Sci Int. 2013;231:42–53.

6.Kesha K, Boggs CL, Ripple MG, et al. Methylenedioxypyrovalerone (“bath salts”), related death: case report and review of the literature. J Forensic Sci. 2013;58:1654–9.

7.Jerry J, Collins G, Streem D. Synthetic legal intoxicating drugs: the emerging “incense” and “bath salt” phenomenon. Cleve Clin J Med. 2012;79:258–64.

8.Ross EA, Watson M, Goldberger B. “bath salts” intoxication. N Engl J Med. 2011;365:967–8.

9.Regunath H, Ariyamuthu VK, Dalal P, Misra M. Bath salt intoxication causing acute kidney injury requiring hemodialysis. Hemodial Int. 2012;16:S47–9.

10.Marinetti LJ, Antonides HM. Analysis of synthetic cathinones commonly found in bath salts in human performance and postmortem toxicology: method development, drug distribution and interpretation of results. J Anal Toxicol. 2013;37:135–46.

11.Swortwood MJ, Boland DM, DeCaprio AP. Determination of 32 cathinone derivatives and other designer drugs in serum by comprehensive LC-QQQ-MS/MS analysis. Anal Bioanal Chem. 2012;405:1383–97.

12.Spiller HA, Ryan ML, Weston RG, Jansen J. Clinical experience with and analytical confirmation of “bath salts” and “legal highs” (synthetic cathinones) in the United States. Clin Toxicol. 2011;49:499–505.

13.Férec S, Bretaudeau-Deguigne M, Lelièvre B, et al. Expositions récréatives de 8 patients aux nouvelles drogues de synthèse obtenues sur Internet : à propos de 3,4-méthylènedioxypyrovalérone (MDPV) et de méthoxétamine (MXE). Ann Toxicol Anal. 2013;25:47–56.

14.Wyman JF, Lavins ES, Engelhart D, et al. Postmortem tissue distribution of MDPV following lethal intoxication by “bath salts.”. J Anal Toxicol. 2013;37:182–5.

15.Kriikku P, Wilhelm L, Schwarz O, Rintatalo J. New designer drug of abuse: 3,4-Methylenedioxypyrovalerone (MDPV). Findings from apprehended drivers in Finland. Forensic Sci Int. 2011;210:195–200.

16.Mugele J, Nañagas KA, Tormoehlen LM. Serotonin syndrome associated with MDPV use: a case report. Ann Emerg Med. 2012;60:100–2.

17.Fröhlich S, Lambe E, O’Dea J. Acute liver failure following recreational use of psychotropic “head shop” compounds. Ir J Med Sci. 2011;180:263–4.

18.Thornton SL, Gerona RR, Tomaszewski CA. Psychosis from a bath salt product containing Flephedrone and MDPV with serum, urine, and product quantification. J Med Toxicol. 2012;8:310–3.

19.Penders TM, Gestring R. Hallucinatory delirium following use of MDPV: “Bath Salts.”. Gen Hosp Psychiatry. 2011;33:525–6.

20.Bertol E, Mari F, Boscolo Berto R, et al. A mixed MDPV and benzodiazepine intoxication in a chronic drug abuser: determination of MDPV metabolites by LC–HRMS and discussion of the case. Forensic Sci Int. 2014;243:149–55.

21.Centers for Disease Control and Prevention (CDC). Emergency department visits after use of a drug sold as “bath salts”--Michigan, November 13, 2010-March 31, 2011. MMWR Morb Mortal Wkly Rep. 2011;60:624–7.

22.Namera A, Urabe S, Saito T, et al. A fatal case of 3,4-methylenedioxypyrovalerone poisoning: coexistence of α-pyrrolidinobutiophenone and α-pyrrolidinovalerophenone in blood and/or hair. Forensic Toxicol. 2013;31:338–43.

23.Young AC, Schwarz ES, Velez LI, Gardner M. Two cases of disseminated intravascular coagulation due to “bath salts” resulting in fatalities, with laboratory confirmation. Am J Emerg Med. 2013;31:445.e3–5.

24.Nichols DE, Frescas S. Improvements to the synthesis of psilocybin and a facile method for preparing the O-acetyl prodrug of psilocin. Synthesis. 1999;1999:935–8.

25.Baumann MH, Partilla JS, Lehner KR, et al. Powerful cocaine-like actions of 3,4-methylenedioxypyrovalerone (MDPV), a principal constituent of psychoactive “bath salts” products. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2013;38:552–62.

26.Gill JR. Practical toxicology for the forensic pathologist. In: Tsokos M, editor. Forensic pathology reviews. New Jersey: Humana Press; 2005. p. 243–69.

27.Vilke GM, DeBard ML, Chan TC, et al. Excited delirium syndrome (ExDS): defining based on a review of the literature. J Emerg Med. 2012;43:897–905.

28.Meyer MR, Du P, Schuster F, Maurer HH. Studies on the metabolism of the α-pyrrolidinophenone designer drug methylenedioxy-pyrovalerone (MDPV) in rat and human urine and human liver microsomes using GC–MS and LC–high-resolution MS and its detectability in urine by GC–MS. J Mass Spectrom. 2010;45:1426–42.
All items in Spectrum are protected by copyright, with all rights reserved. The use of items is governed by Spectrum's terms of access.

Repository Staff Only: item control page

Downloads per month over past year

Research related to the current document (at the CORE website)
- Research related to the current document (at the CORE website)
Back to top Back to top