Ecstasy (MDMA) toxicity: Difference between revisions
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==Background== | |||
*3,4-methylenedioxymethamphetamine (MDMA) | *3,4-methylenedioxymethamphetamine (MDMA) | ||
*other names: E, X, XTC, Adam, Stacy | *other names: E, X, XTC, Adam, Stacy | ||
| Line 8: | Line 7: | ||
*typical tablets contain 50-100mg of ecstatsy (although other substances possible) | *typical tablets contain 50-100mg of ecstatsy (although other substances possible) | ||
==Clinical Features== | |||
*most people report euphoria | *most people report euphoria | ||
*AMS | *AMS | ||
| Line 24: | Line 22: | ||
*hepatotoxicity | *hepatotoxicity | ||
==Workup== | |||
*Accucheck, ISTAT | *Accucheck, ISTAT | ||
*urine pregnancy | *urine pregnancy | ||
| Line 37: | Line 34: | ||
*LP as indicated to rule out meningitis | *LP as indicated to rule out meningitis | ||
==Treatment== | |||
*ABCs | *ABCs | ||
*IV, O2, monitor | *IV, O2, monitor | ||
| Line 48: | Line 44: | ||
*Rhabdo: foley, IVF | *Rhabdo: foley, IVF | ||
==Disposition== | |||
*Admit pt's with complications of ingestion | *Admit pt's with complications of ingestion | ||
*Discharge those who are asymptomatic and no life threatening complication | *Discharge those who are asymptomatic and no life threatening complication | ||
==Sources== | |||
Harwood-Nuss, Rosens, EMedicine | Harwood-Nuss, Rosens, EMedicine | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 18:35, 14 September 2012
Background
- 3,4-methylenedioxymethamphetamine (MDMA)
- other names: E, X, XTC, Adam, Stacy
- causes catecholamine release, serotonin release, and inhibits serotonin re-uptake
- "rave" parties
- 1-2 mg/kg effective dose; onset 30min-1 hour, peak 4 hours, lasts 8-24 hours
- typical tablets contain 50-100mg of ecstatsy (although other substances possible)
Clinical Features
- most people report euphoria
- AMS
- agitation
- tachycardia, palpitations, HTN
- serotonin syndrome (AMS, hyperthermia, rigidity, autonomic instability)
- GI symptoms
- dehydration
- bruxism (jaw clenching/grinding)
- hyperthermia
- hyponatremia (from sweat loss, free water intake, and SIADH like effect)
- seizure
- mydriasis
- hepatotoxicity
Workup
- Accucheck, ISTAT
- urine pregnancy
- CBC, BMP, LFTs, coags, tylenol, aspirin
- CK
- ECG
- UA
- Tox screen, blood alcohol
- serum osmoles, urine Na (if hyponatremia present)
- Head CT as indicated
- LP as indicated to rule out meningitis
Treatment
- ABCs
- IV, O2, monitor
- Agitation: benzos, haldol
- Seizure: benzos, phenobarbital (20mg/kg), propofol; avoid dilantin; manage airway as indicated
- Seizure AND hyponatremia: hypertonic saline (3% NS) 2-3 ml/kg IV bolus until sz stops (need to raise serum Na by 3-5 meq/L)
- Hyponatremia: fluids restrict most pt's, unless hypovolemic. correct Na slowly: 0.5 meq/h; 10-12 meq/24h
- Hyperthermia: ice packs, cold IVF, consider dantrolene 1mg/kg IV
- Rhabdo: foley, IVF
Disposition
- Admit pt's with complications of ingestion
- Discharge those who are asymptomatic and no life threatening complication
Sources
Harwood-Nuss, Rosens, EMedicine