Ecstasy (MDMA) toxicity: Difference between revisions
| Line 33: | Line 33: | ||
*Blood and urine cultures if signs of infection | *Blood and urine cultures if signs of infection | ||
*Consider LP to exclude meningitis | *Consider LP to exclude meningitis | ||
==Differential Diagnosis== | |||
{{Sympathomimetic types}} | |||
==Treatment== | ==Treatment== | ||
===Prehospital=== | ===Prehospital=== | ||
*Primary focus should be on controlling agitation as well as ABCs | *Primary focus should be on controlling agitation as well as ABCs | ||
===ABCs=== | ===ABCs=== | ||
*IV, O2, monitor | *IV, O2, monitor | ||
===Agitation=== | ===Agitation=== | ||
**Sedation with [[Benzodiazepines]] as needed | **Sedation with [[Benzodiazepines]] as needed | ||
| Line 51: | Line 56: | ||
{{Symptomatic Hyponatremia Treatment}} | {{Symptomatic Hyponatremia Treatment}} | ||
*Goal should be to raise serum Na by 3-5 meq/L) | *Goal should be to raise serum Na by 3-5 meq/L) | ||
===[[Hyponatremia]]=== | ===[[Hyponatremia]]=== | ||
*Fluids restrict most patients, unless hypovolemic. | *Fluids restrict most patients, unless hypovolemic. | ||
*Correct Na slowly: 0.5 meq/h; 10-12 meq/24h | *Correct Na slowly: 0.5 meq/h; 10-12 meq/24h | ||
===[[Hyperthermia]]=== | ===[[Hyperthermia]]=== | ||
*Ice packs, cold IVF, | *Ice packs, cold IVF, | ||
Revision as of 03:04, 16 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
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Treatment
Prehospital
- Primary focus should be on controlling agitation as well as ABCs
ABCs
- IV, O2, monitor
Agitation
- Sedation with Benzodiazepines as needed
- Consider Haldol
Seizure
- Benzodiazepines
- Phenobarbital (20mg/kg) or propofol as second line agents
- avoid dilantin
- manage airway as indicated
Seizure AND Hyponatremia
Template:Symptomatic Hyponatremia Treatment
- Goal should be to raise serum Na by 3-5 meq/L)
Hyponatremia
- Fluids restrict most patients, unless hypovolemic.
- Correct Na slowly: 0.5 meq/h; 10-12 meq/24h
Hyperthermia
- Ice packs, cold IVF,
- Rhabdomyolysis
- Foley, IVF, goal urine output > 2cc/kg
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