Overdose - Can someone with TOXBASE access get data on 4-mmc

[guile]

SWIM needs Toxbase (Poisons Unit) info on 4-mmc, also as much as possible on legal pills. SWIM knows someone but can't ask them again as they helped fill in the blanks on GBL. SWIM doesn't want to reveal that he's naively taken another drug where even no academic research is known.

SWIM Thinks it will be so helpful...

guile added 400 Minutes and 42 Seconds later...

Originally Posted by guile

SWIM needs Toxbase (Poisons Unit) info on 4-mmc, also as much as possible on legal pills. SWIM knows someone but can't ask them again as they helped fill in the blanks on GBL. SWIM doesn't want to reveal that he's naively taken another drug where even no academic research is known.

SWIM Thinks it will be so helpful...

Got passed on the following information from someone in healthcare who thinks it is in the public interest to be shown. Who I only know as ANON. I do not this person.

Mephedrone
Updated 11/2009




Type of Product
Drug of abuse.
 

• 1Synonyms
• 2Ingredients
• 3Toxicity
• 4Features
• 5Management

[top]Synonyms

2-methylamino-1-p-tolylpropan-1-one, 4-methylmethcathinone, 4-MMC, Sub Coca I.
Caution: using a slang term to try and identify a drug of abuse is potentially dangerous since there are many regional variations and the terms change over time.

[top]Ingredients

4-methylmethcathinone
Caution: the purity of street drugs may vary greatly.

[top]Toxicity

Little information is available on the effects of this drug. Mephedrone (4-methylmethcathinone) is derived from methcathinone, which in turn may be derived from cathinone, one of the active ingredients in khat (cathula edulis Forsk), or synthesised from pseudoephedrine. Toxicity may be similar to that of amfetamines.

UNCOMMON PRODUCTS This is a product about which little information is available. Knowledge of its toxicity is limited. To help other clinicians dealing with similar cases please click here to give us details of your case.

NHS Direct /NHS 24/Primary Care All children who have been exposed to this drug should be assessed by a physician.
Amfetamines - features and management
Updated 10/2009

[top]Features

Amfetamines may cause euphoria, increase alertness, intensify emotions and boost self-esteem.
In addition tremor, sweating, dilated pupils, agitation, confusion, headache, anxiety, vomiting, abdominal pain, seizures, hallucinations or delusions. Chest pain, palpitations, dyspnoea, systemic hypotension or hypertension may occur. Commonly, narrow-complex tachycardia or rarely ventricular fibrillation may occur. Hyperpyrexia may be severe. Metabolic acidosis may also occur.
In severe cases stroke, myocardial infarction, rhabdomyolysis, DIC and renal failure may occur. Hepatocellular damage has also been reported. Crystal methamphetamine has caused near-fatal pulmonary oedema.
Intravenous amfetamine abuse has been complicated by acute cardiomyopathy.
Poor prognostic signs include persistent seizures, hyperthermia, coma, or focal neurological signs.

[top]Management

1.
Ensure a clear airway and adequate ventilation if consciousness is impaired.
2.
The benefit of gastric decontamination is uncertain. Consider oral activated charcoal (charcoal dose: 50 g for an adult, 1 g/kg for a child) if any amount of an amfetamine has been ingested within 1 hour.
3.
Observe for at least 4 hours if asymptomatic.
4.
Monitor conscious level, pulse, blood pressure, cardiac rhythm and body temperature at least every 30 minutes.
5.
Perform a 12-lead ECG.
6.
Measure urea, electrolytes, creatinine, liver function tests and creatine kinase if features of toxicity are present.
7.
Agitated adults can be sedated with oral or IV diazepam (0.1-0.3 mg/kg body weight). If ineffective consider oral (5-10 mg) or parenteral (2.5-10 mg) haloperidol.
In children it is better to manage agitation without sedation. Exclude other causes (e.g. hypoxia, infection, hypoglycaemia). Consider nursing in a dark and quiet environment with a close relative present; seek expert paediatric advice. If required, for children over 3 years IV midazolam is generally the most appropriate drug for managing agitation and requires specialist paediatric care.
8.
Single brief convulsions do not require treatment. If frequent or prolonged control with intravenous diazepam (10-20 mg [0.1-0.3 mg/kg body weight] in adults; 0.1-0.3 mg/kg body weight in children) or lorazepam (4 mg in an adult and 0.05 mg/kg in a child). Give oxygen and correct acid base and metabolic disturbances as required. Phenytoin (loading dose 15 mg/kg IV infusion in adults and children) may be useful if convulsions are unresponsive to above measures, given slowly (over 20-30 minutes – see BNF) with BP and ECG monitoring.
9.
If metabolic acidosis persists despite correction of hypoxia and adequate fluid resuscitation consider correction with intravenous sodium bicarbonate. Rapid correction is particularly important if there is prolongation of the QRS or QT intervals.

For adults an initial dose of 50 mmol sodium bicarbonate may be given and repeated as necessary, guided by arterial blood gas monitoring (aim for a pH of 7.5). The volumes for different concentrations of sodium bicarbonate are shown here.
Recheck acid base status after administration of sodium bicarbonate. Large amounts of bicarbonate (several hundred mL) with repeated pH checking, may ultimately be required to correct the metabolic acidosis. Monitor electrolytes regularly since there is a risk of hypernatraemia and hypokalaemia if substantial amounts of bicarbonate have been administered.
Children: 1 mL/kg 8.4% bicarbonate diluted in 0.5L 5% dextrose or normal saline at 2-3 mL/kg/hour.
Click here for further information on metabolic acidosis
10.
Narrow-complex tachycardia with cardiac output is best left untreated. Short-acting beta-blockers (e.g. metoprolol 5-10 mg intravenously or esmolol 5-10 mg intravenously for an adult) should be used in extreme cases.
11.
If the systolic BP > 220 and/or diastolic > 140 mm Hg in adults in the absence of long-standing hypertension give diazepam (0.1-0.3 mg/kg body weight). Repeat doses may be necessary.
Persistent hypertension may respond to IV nitrates e.g. GTN starting at 1-2 mg/hour according to clinical response.
Other antihypertensive agents may be effective but can be associated with adverse effects therefore:

If hypertension is unresponsive to the above measures discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
In a child:
Discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
12.
Correct hypotension by raising the foot of the bed and by giving an appropriate fluid challenge. Where hypotension is thought secondary to negative chronotropic and inotropic effects, with little evidence of systemic vasodilatation, then beta adrenergic agonists such as dobutamine may be of benefit. The dose of inotrope should be titrated against blood pressure.
If severe hypotension persists despite the above measures, central venous pressure monitoring should be considered.
13.

Mild hyperthermia should be treated with conventional cooling measures. However, when body temperature exceeds 39-40 degrees centigrade aggressive cooling measures such as ice-baths and sedation (diazepam 0.1-0.3 mg/kg body weight) should be used.
If hyperthermia persists despite the above measures discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
Dantrolene may be considered (1 mg/kg by rapid intravenous injection to a maximum of 10 mg/kg).

Consider other causes as hyperthermia may be caused by conditions other than poisoning.
14.
If the CK is raised or rhabdomyolysis is suspected then there are theoretical reasons why volume replacement and urine alkalinization may be helpful in preventing or reducing the severity of rhabdomyolysis-induced renal failure. There is no strong evidence base from randomised controlled trials in poisoning but there is some evidence in crush injury. Give volume replacement and 225 mmol of 8.4% sodium bicarbonate over two hours to increase the urine pH >7. Haemodialysis or haemofiltration may be required for cases of acute renal failure or severe hyperkalaemia.
15.
Other measures as indicated by the patient's clinical condition.

Reputation Comments on this post:

Thank you for finding this absolutely vital information

[lineartransform]

Any chance this could be compared to the entry for amphetamines? It seems to SWIM that this may be a copy and paste from the amphetamines entry due to lack of information on this particular substituted amphetamine.

[guile]

MDMA

Updated Updated 09/2009





Type of Product


Hallucinogenic amphetamine.
Synonyms


Acid (also used for LSD), ADAM, AKA, Apples, Bart Simpson, Denis the Menace, Disco biscuits, Doves, E, Ecsta, Mitsubishi, Pills, Red and Black, Tabs (also used for LSD), White Burger, White Dove, Yellow Burger, XTC, Play Station.
NB "Ecstasy" is used for several different agents - see Ecstasy entry
Caution: using a slang term to try and identify a drug of abuse is potentially dangerous since there are many regional variations and the terms change over time.
Ingredients


3,4-methylenedioxymethamfetamine (MDMA) usually 30-150 mg/dose (tablet or powder)
NB Reports from Belgium of tablets containing 200-300 mg MDMA - click for further information
Toxicity


MDMA causes release of serotonin, and to a lesser extent dopamine, in the brain. Central and peripheral catecholamine release also occurs.
MDMA tablets are often mixed with a combination of other drugs such as amphetamines, caffeine, ephedrine and pseudoephedrine. There was one report in 2000 of an 'ecstasy' (MDMA) tablet contaminated with strychnine.
Severe and fatal idiopathic reactions can follow ingestion of amounts which were previously tolerated. Early deaths are usually due to cardiac arrhythmias and late ones (24-48 hours post-ingestion) from a syndrome resembling neuroleptic malignant syndrome. Underlying disease such as hypertension or cardiomyopathy may be uncovered. The half-life of MDMA is 7.6 hours.
Use of MDMA during pregnancy may be associated with a significantly increased risk of congenital defects (McElhatton 1999).

NHS Direct /NHS 24/Primary Care All children and symptomatic adults should be referred for medical assessment.

Features


Effects occur within 1 hour and last 4-6 hours after 75-150 mg, and up to 48 hours after 100-300 mg.
Severe toxic features are usually idiosyncratic and unrelated to dose ingested or previous duration of exposure.
General
Common features include tachycardia, mild hypertension, dilated pupils, dry mouth, sweating, anorexia, mood elevation and euphoria. In some cases transient nausea, jaw clenching, confusion, dizziness, ataxia, nystagmus, abdominal pain and diarrhoea may occur.
Features of severe toxicity include cardiac arrhythmias, hyponatraemia., convulsions, delirium, coma, hypotension and cardiovascular collapse.
MDMA use can cause serotonin syndrome, presumably via stimulation of massive serotonin release, with hyperpyrexia, muscle rigidity, hyperreflexia, rhabdomyolysis, metabolic acidosis, renal failure and disseminated intravascular coagulation.
Acute or chronic hepatic damage may occur leading to fulminant hepatic failure.
Cerebral haemorrhage, cerebral venous sinus thrombosis, aplastic anaemia and pneumomediastinum have also been reported.
Neuropsychiatric
Use of MDMA can cause memory impairment, poor concentration, sleep disturbance, flashbacks and hallucinations. Depression, panic attacks, anxiety and psychosis have also been reported.
Management


1. Ensure a clear airway and adequate ventilation if consciousness is impaired.
2. The benefit of gastric decontamination is uncertain. Consider activated charcoal (50 g for adults; 1 g/ kg for children) if the patient presents within 1 hour of ingestion.
3. Observe for at least 4 hours if asymptomatic.
4. Monitor pulse, blood pressure, cardiac rhythm and body temperature.
5. Perform a 12 lead ECG.
6. Measure urea, electrolytes, creatinine, liver function tests and creatine kinase. If features of severe toxicity are present monitor coagulation and arterial blood gases.
7. If agitated, sedate with oral or IV or rectal diazepam (initially 0.1-0.3 mg/kg body weight). Repeat doses may be required. If psychotic consider oral (5-10 mg) or parenteral (2.5-10 mg) haloperidol.
Children under 3 years are easier to control without sedation. For children over 3 years 0.4 mg/kg diazepam orally is an appropriate dose for sedation.
8. Single brief convulsions do not require treatment. If frequent or prolonged control with intravenous diazepam (10-20 mg in adults; 0.1-0.3 mg/kg body weight) or lorazepam (4 mg in an adult and 0.05 mg/kg in a child). Give oxygen and correct acid base and metabolic disturbances as required. Phenytoin (loading dose 15 mg/kg IV infusion in adults and children) may be useful if convulsions are unresponsive to above measures, given slowly (over 20-30 minutes - see BNF) with BP and ECG monitoring.
9.
If metabolic acidosis persists despite correction of hypoxia and adequate fluid resuscitation consider correction with intravenous sodium bicarbonate. Rapid correction is particularly important if there is prolongation of the QRS or QT intervals.

For adults an initial dose of 50 mmol sodium bicarbonate may be given and repeated as necessary, guided by arterial blood gas monitoring (aim for a pH of 7.5). The volumes for different concentrations of sodium bicarbonate are shown here.
Recheck acid base status after administration of sodium bicarbonate. Large amounts of bicarbonate (several hundred mL) with repeated pH checking, may ultimately be required to correct the metabolic acidosis. Monitor electrolytes regularly since there is a risk of hypernatraemia and hypokalaemia if substantial amounts of bicarbonate have been administered.
Children: 1 mL/kg 8.4% bicarbonate diluted in 0.5L 5% dextrose or normal saline at 2-3 mL/kg/hour.
Click here for further information on metabolic acidosis
10. Treat symptomatic narrow complex tachycardias in an adult with beta-blockers (eg metoprolol 5-10 mg IV or esmolol (to a total of 5-10 mg IV as a starting dose for an adult).
11. If the systolic BP > 220 and diastolic > 140 mm Hg in the absence of long-standing hypertension give diazepam (0.1-0.3 mg/kg body weight in adults and children). Repeat doses may be necessary.
Persistent hypertension may respond to IV nitrates e.g. GTN 1-2 mg/hour and titrate dose according to clinical response.


Other antihypertensive agents may be effective but can be associated with adverse effects therefore:
If hypertension is unresponsive to the above measures discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
In a child:

Discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
12. Correct hypotension by raising the foot of the bed and by giving an appropriate fluid challenge. Where hypotension is thought secondary to negative chronotropic and inotropic effects, with little evidence of systemic vasodilatation, then beta adrenergic agonists such as dobutamine or low dose dopamine (2-10 micrograms/kg/min) may be of benefit. The dose of inotrope should be titrated against blood pressure.
If severe hypotension persists despite the above measures, central venous pressure monitoring should be considered.
If severe hypotension persists despite the above measures discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
13. Consider intravenous verapamil (5-10 mg over 2-3 minutes) for narrow complex tachycardia, which has not settled with diazepam (Avoid in patient with acute myocardial infarction and pulmonary oedema).
14.
Mild hyperthermia should be treated with conventional cooling measures. However, when body temperature exceeds 39-40 degrees centigrade aggressive cooling measures such as ice-baths and sedation (diazepam 0.1-0.3 mg/kg body weight) should be used.

If hyperthermia persists despite the above measures discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.

Dantrolene may be considered (1 mg/kg by rapid intravenous injection to a maximum of 10 mg/kg).
Consider other causes as hyperthermia may be caused by conditions other than poisoning.
15.
If the CK is raised or rhabdomyolysis is suspected then there are theoretical reasons why volume replacement and urine alkalinization may be helpful in preventing or reducing the severity of rhabdomyolysis-induced renal failure. There is no strong evidence base from randomised controlled trials in poisoning but there is some evidence in crush injury. Give volume replacement and 225 mmol of 8.4% sodium bicarbonate over two hours to increase the urine pH >7. Haemodialysis or haemofiltration may be required for cases of acute renal failure or severe hyperkalaemia.
16. Hepatic failure should be treated by conventional measures. Liver transplantation has been successfully used in cases of fulminant hepatic failure with encephalopathy, coagulopathy and acidosis.
17.
Other measures as indicated by the patient's clinical condition.
Links


Nursing guide - MDMA
References
Activated Charcoal
Dantrolene Doses
Ecstasy in pregnancy
Serotonin Syndrome

guile added 6 Minutes and 28 Seconds later...

Originally Posted by lineartransform

Any chance this could be compared to the entry for amphetamines? It seems to SWIM that this may be a copy and paste from the amphetamines entry due to lack of information on this particular substituted amphetamine.

Amphetamines

Updated Revised 10/2008





Type of Product


A sympathomimetic drug of abuse.
Synonyms


A, Aimies (also used for amyl nitrite), Amphet, Amphetamine, Bennies, Billy Whiz, Black Beauties, Bumblebees, Clear Rocks, Co-pilots, Crank, Croke, Glass, Ice (also used for cocaine), LA Turnarounds, Mollies (also used for TFMPP), Oranges, Pep Pills, Pink Champagne, Pink Speed Bombs, Rippers, Rocks, Speed, Splash, Sulph, Sulphate, Wake Ups, Whizz.
Caution: using a slang term to try and identify a drug of abuse is potentially dangerous since there are many regional variations and the terms change over time.
Ingredients


Street amfetamine usually contains up to 5% amfetamine along with inert fillers or other stimulants.
Caution: the purity of street drugs may vary greatly.
Toxicity


The acute lethal dose of amfetamine in adults has been reported to be 20-25 mg/kg (Zalis and Parmley 1963) but individual response varies greatly due to tolerance and toxicity correlates poorly with the amount taken.
Snorting, smoking or injecting amfetamine intravenously gives faster and more intense effects than ingestion.
The elimination half-life of amfetamine is dependent on urine pH (Anggård et al 1973):
pH <6.6 Half-life = 7-14 hours
pH >6.7 Half-life = 18-34 hours

NHS Direct /NHS 24/Primary Care All children who have been exposed to this drug should be assessed by a physician.
Amfetamines - features and management
Updated 10/2009

Features


Amfetamines may cause euphoria, increase alertness, intensify emotions and boost self-esteem.
In addition tremor, sweating, dilated pupils, agitation, confusion, headache, anxiety, vomiting, abdominal pain, seizures, hallucinations or delusions. Chest pain, palpitations, dyspnoea, systemic hypotension or hypertension may occur. Commonly, narrow-complex tachycardia or rarely ventricular fibrillation may occur. Hyperpyrexia may be severe. Metabolic acidosis may also occur.
In severe cases stroke, myocardial infarction, rhabdomyolysis, DIC and renal failure may occur. Hepatocellular damage has also been reported. Crystal methamphetamine has caused near-fatal pulmonary oedema.
Intravenous amfetamine abuse has been complicated by acute cardiomyopathy.
Poor prognostic signs include persistent seizures, hyperthermia, coma, or focal neurological signs.
Management


1.
Ensure a clear airway and adequate ventilation if consciousness is impaired.
2.
The benefit of gastric decontamination is uncertain. Consider oral activated charcoal (charcoal dose: 50 g for an adult, 1 g/kg for a child) if any amount of an amfetamine has been ingested within 1 hour.
3.
Observe for at least 4 hours if asymptomatic.
4.
Monitor conscious level, pulse, blood pressure, cardiac rhythm and body temperature at least every 30 minutes.
5.
Perform a 12-lead ECG.
6.
Measure urea, electrolytes, creatinine, liver function tests and creatine kinase if features of toxicity are present.
7.
Agitated adults can be sedated with oral or IV diazepam (0.1-0.3 mg/kg body weight). If ineffective consider oral (5-10 mg) or parenteral (2.5-10 mg) haloperidol.
In children it is better to manage agitation without sedation. Exclude other causes (e.g. hypoxia, infection, hypoglycaemia). Consider nursing in a dark and quiet environment with a close relative present; seek expert paediatric advice. If required, for children over 3 years IV midazolam is generally the most appropriate drug for managing agitation and requires specialist paediatric care.
8.
Single brief convulsions do not require treatment. If frequent or prolonged control with intravenous diazepam (10-20 mg [0.1-0.3 mg/kg body weight] in adults; 0.1-0.3 mg/kg body weight in children) or lorazepam (4 mg in an adult and 0.05 mg/kg in a child). Give oxygen and correct acid base and metabolic disturbances as required. Phenytoin (loading dose 15 mg/kg IV infusion in adults and children) may be useful if convulsions are unresponsive to above measures, given slowly (over 20-30 minutes – see BNF) with BP and ECG monitoring.
9.
If metabolic acidosis persists despite correction of hypoxia and adequate fluid resuscitation consider correction with intravenous sodium bicarbonate. Rapid correction is particularly important if there is prolongation of the QRS or QT intervals.

For adults an initial dose of 50 mmol sodium bicarbonate may be given and repeated as necessary, guided by arterial blood gas monitoring (aim for a pH of 7.5). The volumes for different concentrations of sodium bicarbonate are shown here.
Recheck acid base status after administration of sodium bicarbonate. Large amounts of bicarbonate (several hundred mL) with repeated pH checking, may ultimately be required to correct the metabolic acidosis. Monitor electrolytes regularly since there is a risk of hypernatraemia and hypokalaemia if substantial amounts of bicarbonate have been administered.
Children: 1 mL/kg 8.4% bicarbonate diluted in 0.5L 5% dextrose or normal saline at 2-3 mL/kg/hour.
Click here for further information on metabolic acidosis
10.
Narrow-complex tachycardia with cardiac output is best left untreated. Short-acting beta-blockers (e.g. metoprolol 5-10 mg intravenously or esmolol 5-10 mg intravenously for an adult) should be used in extreme cases.
11.
If the systolic BP > 220 and/or diastolic > 140 mm Hg in adults in the absence of long-standing hypertension give diazepam (0.1-0.3 mg/kg body weight). Repeat doses may be necessary.
Persistent hypertension may respond to IV nitrates e.g. GTN starting at 1-2 mg/hour according to clinical response.
Other antihypertensive agents may be effective but can be associated with adverse effects therefore:

If hypertension is unresponsive to the above measures discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
In a child:
Discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
12.
Correct hypotension by raising the foot of the bed and by giving an appropriate fluid challenge. Where hypotension is thought secondary to negative chronotropic and inotropic effects, with little evidence of systemic vasodilatation, then beta adrenergic agonists such as dobutamine may be of benefit. The dose of inotrope should be titrated against blood pressure.
If severe hypotension persists despite the above measures, central venous pressure monitoring should be considered.
13.

Mild hyperthermia should be treated with conventional cooling measures. However, when body temperature exceeds 39-40 degrees centigrade aggressive cooling measures such as ice-baths and sedation (diazepam 0.1-0.3 mg/kg body weight) should be used.
If hyperthermia persists despite the above measures discuss with your local poisons information service: in the UK NPIS 0844 892 0111, in Ireland NPIC (01) 809 2566.
Dantrolene may be considered (1 mg/kg by rapid intravenous injection to a maximum of 10 mg/kg).

Consider other causes as hyperthermia may be caused by conditions other than poisoning.
14.
If the CK is raised or rhabdomyolysis is suspected then there are theoretical reasons why volume replacement and urine alkalinization may be helpful in preventing or reducing the severity of rhabdomyolysis-induced renal failure. There is no strong evidence base from randomised controlled trials in poisoning but there is some evidence in crush injury. Give volume replacement and 225 mmol of 8.4% sodium bicarbonate over two hours to increase the urine pH >7. Haemodialysis or haemofiltration may be required for cases of acute renal failure or severe hyperkalaemia.
15.
Other measures as indicated by the patient's clinical condition.



Nursing guide - amfetamine
References
Activated charcoal
Body packing
Amfetamine in pregnancy
Drugs of abuse - time limits for detection







guile added 75 Minutes and 3 Seconds later...

Originally Posted by lineartransform

Any chance this could be compared to the entry for amphetamines? It seems to SWIM that this may be a copy and paste from the amphetamines entry due to lack of information on this particular substituted amphetamine.

Yes it is a standard procedure at large for polydrug detoxification so the creator would be stupid not to copy and paste the standard management procedure,

SWIM has seen that there are differences between different drugs in the same amphetamine, please do not draw any safety conclusions or view from these documents unless your a medical professional.

QUANTITATIVE TOXICITY DATA is what is missing from 4-mmc but is present with other drugs (The life saving indication of how toxic a dose in relation to mass- how serious the overdose is)

(from amfetamine not 4mmc )
Toxicity


The acute lethal dose of amfetamine in adults has been reported to be 20-25 mg/kg (Zalis and Parmley 1963) but individual response varies greatly due to tolerance and toxicity correlates poorly with the amount taken.
Snorting, smoking or injecting amfetamine intravenously gives faster and more intense effects than ingestion.
The elimination half-life of amfetamine is dependent on urine pH (Anggård et al 1973):
pH <6.6 Half-life = 7-14 hours
pH >6.7 Half-life = 18-34 hours

Guiles provisional Conclusion

Toxbase in their own admission have no quantitative data on what constitutes a lethal or high dosage of 4-MMC. They merely state the obvious; that the structure is related to Khat in relation to the active ingredient. They then goto say

This is a product about which little information is available. Knowledge of its toxicity is limited. To help other clinicians dealing with similar cases please click here to give us details of your case.

. They then only can suggest to treat it as an amfetamine (I guess they again have no better solution as little is known).

The bottom line is if you overdose on 4-mmc then there is no scale to determine how intoxicated you are, the only option is to treat by observation of features and standard blood tests. SWIM knows that it is very common for poly drug overdoses to affect blood PH and CK, the treatment is Dialysis.

SWIM knows someone who took a poly drug, collapsed walking home, got hyperthermia found hours later, took his last own breathes on the street in the ambulance crews hands. Assisted breathing was performed on route to hospital. The ECG showed a trace. The person was put on a ventilator if the machine was turned off he would've died. The medics didn't know what person had taken- he was in a coma. They noticed his blood levels were the most abnormal they had seen PH wrong and high CK levels. A state of rhabdomyolysis was observed from blood gases. They had no poison data, all they had was his mobile phone. But there was too many numbers to call and the consensus was no-one was providing helpful information in regards to the poison taken. Immediate dialysis was the only option to treat this unknown poison and drip lines with sodium bacarbonate in. Plus a catheter was fitted. A couple of days later SWIM awakes to medics shouting "BREATHE"- he had lost the reflex due to the machine. SWIM awakes not being able to talk with a tube down his throat. A doctor tells him he's in intensive care. After spending a couple of weeks in intensive care he found out from the medics what happened. SWIM was very surpised because the last he remembers was walking home. A couple of months t-total (touching nothing) he was allowed to drink a pint. Missed the whole summer. All this from some legal high crap that someone fed him when drinking. (Substance Unknown). SWIM tried mephredrone (in 100% health) 1 year later and said "wtf dude I haven't done drugs except prescribed but I remember something bad about that taste, real bad like morbidly bad". Whether it was 4-mmc derivative or who knows? I know this story to be %100 accurate because I was at his bedside trying to assist the medics in attempting identify his drug usage traits, but nothing came back conventional. SWIM had a horrific experience, nothing was worst then seeing a young lad half dead with lines coming out and a catheter having to be emptied constantly. His treatment cost the NHS £2000 a day, he will forever be in debt to society.

This is a true story, told in brief. The actual events were so dramatic is was beyond dialogue. BTW alcohol was content non existent.

This is what could happen to you if you fuck up on 4-mmc as they seem to use the same protocol for unknown poisons as 4-mmc (hence its toxicity data is deemed as non existent). You might be unlucky enough to experience it all conscious and tell them you took an unknown plant food..of which they don't no how to treat.

SWIM is alive and enjoys life 10x more now. He just says even if you can't turn you back on dodgy drugs then try and minimise harm by taking smaller dosages.

Reputation Comments on this post:

Thank you for this information and valuable recount of events