A 42-year-old man who used drugs died at home and his body was found two months later. Autopsy did not reveal an obvious cause of death, but toxicology screening using liquid chromatography and mass spectrometry detected methoxetamine (MXE), a ketamine analog, and several of its metabolites in blood, urine, and gastric contents. MXE concentrations were 3.6 ng/mL in blood, 70.5 ng/mL in urine, and 18.0 ng/mL in gastric content. No other drugs or poisons were found, so despite the low blood level, MXE likely contributed to the death. The case shows that MXE and its metabolites can be detected in a decomposing body even after two months.
Ibotenic acid and muscimol are the main psychoactive compounds in Amanita pantherina and Amanita muscaria mushrooms. Poisoning with A. pantherina is usually accidental due to confusion with edible species, while A. muscaria intoxication is typically intentional for recreational use. Prognosis is generally good, with rare lethal cases. The authors present a new instrumental method to confirm poisoning by isolating ibotenic acid and muscimol from urine using a strong cation exchanger, followed by derivatization and gas chromatography/mass spectrometry analysis. Concentrations were determined in four individuals intoxicated with A. pantherina. Mass spectra and method validation are provided.