Little-known: ‘Mix of drugs’ can kill
LAST MAY, the metropolitan newspapers reported that five people died during a concert held in Pasay. The deaths were traced to the use of an illegal drug called “ecstasy” (methylenedioxymethamphetamine).
Ecstasy is said to heighten the users’ appreciation of “sounds,” among other things, around them—in the case of the Pasay deaths, the dizzying concert, so that they felt they became part of it. Drugs, such as ecstasy, are amphetamines which, when taken singly or in higher dosage or mixed with another drug, cause many systemic manifestation, including acceleration of the heart rate which may lead to ventricular tachycardia (rapid pulse rate of 100 beats per minute with at least three irregular heartbeats in a row—MedicinePlus, US National Library of Medicine), then fibrillation [rapid uncoordinated twitching movements that replace the normal rhythmic contraction of the heart and may cause a lack of circulation and pulse—freedictionary.com] and eventually death. Drugs that cause this kind of serious complication are referred to as serotonergic.
The first known fatality secondary to the intake of this similar drug occurred in 1984. Libby Zion, the 18-year-old daughter of a prominent New Yorker and writer for the New York Times, was brought to the emergency room of New York Hospital for abdominal pains. She was injected with meperidine, a common pain reliever, and died shortly after. Her case triggered a review of the policies of the emergency room, but nothing came out of it.
Eventually the case was reported in 1988 in the New England Journal of Medicine. It was the first reported case, and the illness was labeled for the first time as the “Serotonin Syndrome.” At the time of her death, Zion was being treated for depression and was taking phenelzine, an antidepressant. Phenelzine makes a deadly combination with meperidine, which was unknown before.
Until today many physicians are not aware of this dangerous or fatal drug combinations, so that when it occurs it is simply written out as a drug reaction or anaphylaxis, as happened to a number of well-known personalities, including Hollywood actress Anna Nicole Smith in 2007, and her son who died in 2006.
A recent news item (“PNP, NBI findings jibe: Drugs killed Pasay partygoers,” Metro, 6/8/16) reported the findings from the autopsies done by the National Bureau of Investigation and the Philippine National Police on four of the victims who died shortly after ingesting or injecting drugs containing amphetamine and others. (The family refused to have an autopsy performed on the fifth victim.) All four died of serious cardiac dysrhythmia. The other findings were secondary to the effects of a failing heart, such as the damages noted in their brains, kidneys and livers.
The deaths were secondary to a little-known illness first reported in 1988, the Serotonin Syndrome, common yet often misdiagnosed and written out simply as a drug reaction. To fully comprehend this fatal drug reaction, one has to read the Libby Zion case and the lengthy review on the Serotonin Syndrome. Both articles appeared in the New England Journal of Medicine in 1988 and 2005, respectively.
—ALBERTO DAYSOG JR., MD, San Juan de Dios Educational Foundation Inc., 2772 Roxas Boulevard, Pasay City
