View source for Ecstasy (MDMA) toxicity

==Background==
[[File:MDMA.png|thumbnail|MDMA]]
[[File:Ecstasy monogram.jpg|thumb|Ecstasy tablets containing MDMA]]
*3,4-methylenedioxymethamphetamine (MDMA) 
*Also known as: Ecstasy, X, Molly, Skittles, Smartees, Beans
*Popular at "rave" parties and EDM festivals
*Causes catecholamine release, serotonin release, and inhibits serotonin re-uptake 
*1-2mg/kg effective dose; onset 30min-1 hour, peak 4 hours, lasts 8-24 hours 
**Typical tablets contain 50-100mg of MDMA

==Clinical Features==
*Euphoria 
*Agitation 
*Tachycardia, palpitations, hypertension 

{| class="wikitable"
|-
! System
!  Minor or moderate overdose || Severe overdose
|-
! Cardiovascular
|
||
* [[Disseminated intravascular coagulation]]
* [[Intracranial hemorrhage]]
* Severe [[hypertension]] or [[hypotension]]
* Hypotensive bleeding
|-
! Central nervous<br />system
|
* Hyperreflexia
* Agitation
* Confusion
* Paranoia
* Stimulant psychosis
|
* Cognitive deficit
* Coma
* [[Seizure]]
* [[Hallucinations]]
* Loss of consciousness
* [[Serotonin syndrome]]
|-
! Musculoskeletal
|
|
* Hypertonia
* [[Rhabdomyolysis]] 
|-
! Respiratory
|
|
* [[Acute respiratory distress syndrome]]
|-
! Urinary
|
|
* [[Acute kidney injury]]
|-
! Other
|
|
* Cerebral edema
* [[Hepatitis]]
* [[Hyperpyrexia]] 
*[[Hyponatremia]] (from sweat loss, free water intake, and SIADH-like effect) <ref>Aitchison KJ, Tsapakis EM, Huezo-Diaz P, Kerwin RW, Forsling ML, Wolff K. Ecstasy (MDMA)-induced hyponatraemia is associated with genetic variants in CYP2D6 and COMT. J Psychopharmacol. 2012;26(3):408-18</ref>
|}

==Differential Diagnosis==
{{Sympathomimetic types}}
{{Drugs of abuse types}}

==Evaluation==
{{Hallucinogen workup}}
*Urine tox fails to detect unless large doses
**More usually positive test for amphetamines
**Confirmation must use specialized lab tests (gas chromatography)

==Management==
*Supportive care is mainstay of treatment
*[[Benzodiazepines]] for agitation, severe hypertension
*Hyperthermia may be severe and requires immediate treatment with active cooling measures
**Morbidity/mortality is related to severity and length of hyperthermia

==Disposition==
*Consider discharge if all symptoms resolve and no complications noted
*Otherwise admit

==References==
<references/>

==See Also==
*[[Sympathomimetic toxicity]]
*[[Amphetamines]]

[[Category:Toxicology]]