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This case report describes a 30\u2010year\u2010old white man who, following a period of nausea and vomiting, was admitted to the hospital with sudden mental status deterioration followed rapidly by clinical deterioration and death. Treating physicians in this case suspected acute illicit drug toxicity with synthetic cathinones based on social history. Clinicians and medical examiners should be aware that the presentation, signs, and symptoms described may indicate an underlying inborn error of metabolism such as <jats:styled-content style=\"fixed-case\">MCAD<\/jats:styled-content> deficiency and take action accordingly.<\/jats:p>","DOI":"10.1111\/1556-4029.12808","type":"journal-article","created":{"date-parts":[[2015,7,31]],"date-time":"2015-07-31T01:53:16Z","timestamp":1438307596000},"page":"1101-1103","source":"Crossref","is-referenced-by-count":5,"title":["Medium\u2010Chain Acyl\u2010CoA Dehydrogenase Deficiency in Adulthood: A Potential Diagnosis in a Patient with Mental Status Changes Suspected of Drug Toxicity"],"prefix":"10.1111","volume":"60","author":[{"given":"Morgan","family":"Randall","sequence":"first","affiliation":[{"name":"University of Kentucky Department of Pathology and Laboratory Medicine Office of the Associate Chief Medical Examiner of the Commonwealth of Kentucky Lexington KY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristin","family":"Rolf","sequence":"additional","affiliation":[{"name":"Division of Laboratory Services Kentucky Department for Public Health Frankfort KY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie Mayfield","family":"Gibson","sequence":"additional","affiliation":[{"name":"Division of Laboratory Services Kentucky Department for Public Health Frankfort KY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9218-6233","authenticated-orcid":false,"given":"Patricia L.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Human Genetics Emory University Atlanta GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piero","family":"Rinaldo","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic Frankfort KY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory J.","family":"Davis","sequence":"additional","affiliation":[{"name":"University of Kentucky Department of Pathology and Laboratory Medicine Office of the Associate Chief Medical Examiner of the Commonwealth of Kentucky Lexington KY"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,29]]},"reference":[{"key":"e_1_2_4_2_1","unstructured":"MaternD RinaldoPMedium\u2010chain acyl\u2010Coenzyme a dehydrogenase deficiency. 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