Ecstasy (MDMA) toxicity: Difference between revisions
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Revision as of 19:04, 9 December 2014
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)
- rhabdomyolysis, myoglobinuria
- DIC
- GI symptoms
- Dehydration
- Bruxism (jaw clenching/grinding)
- Hyperthermia
- Hyponatremia (from sweat loss, free water intake, and SIADH-like effect) [1]
- Seizure
- Mydriasis
- Hepatotoxicity[2]
Workup
Hallucination workup
- Urine pregnancy
- CBC, Metabolic panel, LFTs, coags, APAP level, ASA level
- Total CK level
- ECG
- UA
- Tox screen, blood alcohol
- Serum osmoles, urine Na (if Hyponatremia present)
- Head CT as indicated
- LP to rule out Meningitis if infectious symptoms and based on history and physical
- Urine tox fails to detect unless large doeses
- Positive test for amphetamines if only large doses
- Confirmation must use specialized lab tests (gas chromatography)
- Chest pain w/u if CP present
- Blood and urine cultures if signs of infection
- Consider LP to exclude 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)
- hypertonic saline (3% NS) 2-3 ml/kg IV
- 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
- ↑ 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
- ↑ Carvalho M, Pontes H, Remiao F, Bastos ML, Carvalho F. Mechanisms underlying the hepatotoxic effects of ecstasy. Curr Pharm Biotechnol. 2010;11(5):476-95