• Kilak Kesha, Cassie L Boggs, Mary G Ripple, Carol H Allan, Barry Levine, Rebecca Jufer-Phipps, Suzanne Doyon, PaoLin Chi, and David R Fowler.
• Maryland Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
• J. Forensic Sci. 2013 Nov 1; 58 (6): 1654-9.

AbstractCathinone derivatives (bath salts) have emerged as the latest drugs of abuse. 3,4-methylenedioxypyrovalerone (MDPV) is the primary active ingredient in bath salts used in this country. This article presents the second reported cause of death by MDPV intoxication alone. In April 2011, a delusional man was emergently brought to a hospital, where he self-reported bath salt usage. He became agitated, developed ventricular tachycardia, hyperthermia, and died. Comprehensive alcohol and drug testing was performed. Using the alkaline drug screen, heart blood contained 0.7 mg/L MDPV and peripheral blood contained 1.0 mg/L MDPV. His bizarre behavior with life-threatening hyperthermia was consistent with an MDPV-induced excited delirium state. MDPV is not yet found by routine immunoassay toxicology screens. Testing for MDPV should be considered in cases with a history of polysubstance abuse with stimulant type drugs, report of acute onset of psychogenic symptoms, excited delirium syndrome, or presentation in a hyperthermic state.© 2013 American Academy of Forensic Sciences.

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