Use of Diethylone, a New Psychoactive Substance, Associated with Multi-system Toxicity: A Case Report of Two Patients

Introduction: New Psychoactive Substances (NPS) is a term used to describe synthetic products that may also be referred to as “designer drugs”, “research chemicals”, or “internet drugs”. As new NPS continue to emerge, drug users are exposing themselves to new chemicals with unknown effects. Case report: We report the cases of two patients who reportedly used “Molly” and developed multi-system toxicity requiring Intensive Care Unit (ICU) admission for several days. Both patients presented with altered mental status and during their hospital course manifested neuromuscular hyperactivity and hemodynamic lability. Both patients also had neuropsychiatric symptoms lasting for days after the critical phase of their hospital course. Laboratory investigation using liquid chromatography-quadrupole time-of-flight mass spectrometry identified diethylone in the substance the patients used, and several predicted diethylone metabolites in their sera. Discussion: Clinical effects associated with diethylone use in humans have not previously been described in the medical literature. Our cases highlight diethylone as a new NPS that can be associated with severe and prolonged toxicity.