Combined lethal intoxication involving 2-methyl-2-butanol

The aim was to investigate and clarify the cause of death of a 26-year-old male found dead in his apartment. It was known that the individual used drugs of abuse. In the apartment, the police found amongst others a "brown powder" and a glass bottle labeled with "2-methyl-2-butanol" (2m2b). Autopsy and chemical analyses were performed. The autopsy revealed unspecific morphological signs of an intoxication (cerebral swelling and cyanosis, pulmonary edema, full urine bladder). Headspace gas chromatography with flame ionization detection (HS-GC-FID) was used to determine 2m2b and ethanol. Concentrations of 245 mg/L and 225 mg/L 2m2b could be detected in the femoral vein blood specimen and urine, respectively. Ethanol was detected below the level of quantification (0,2 g/L) in both matrices. The detected blood concentration of 2m2b was more than twice as high as the 2m2b concentration described as comatose in a previous published case report. However, in the presented case further analysis revealed toxic concentrations of methamphetamine and venlafaxine and also identified a previous intake of heroin and diazepam. Thus, a combined drug intoxication was assumed as cause of death. Little is known about the abuse of 2m2b as an alternative to ethanol. Since 2m2b is widely available, cheap, more potent than ethanol, while lacking its hangover effects and is likely not detected by routine HS-GC-FID methods for the detection of blood ethanol concentrations, it may be of forensic relevance.