Ecstasy (MDMA) toxicity: Difference between revisions
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[[File:Ecstasy monogram.jpg|thumb|Ecstasy tablets containing MDMA]] | [[File:Ecstasy monogram.jpg|thumb|Ecstasy tablets containing MDMA]] | ||
*3,4-methylenedioxymethamphetamine (MDMA) | *3,4-methylenedioxymethamphetamine (MDMA) | ||
*Also known as: X, Molly, Skittles, Smartees, Beans | *Also known as: Ecstasy, X, Molly, Skittles, Smartees, Beans | ||
*Popular at "rave" parties and EDM festivals | *Popular at "rave" parties and EDM festivals | ||
*Causes catecholamine release, serotonin release, and inhibits serotonin re-uptake | *Causes catecholamine release, serotonin release, and inhibits serotonin re-uptake | ||
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*Agitation | *Agitation | ||
*Tachycardia, palpitations, hypertension | *Tachycardia, palpitations, hypertension | ||
{| class="wikitable" | {| class="wikitable" | ||
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* Cognitive deficit | * Cognitive deficit | ||
* Coma | * Coma | ||
* | * [[Seizure]] | ||
* [[Hallucinations]] | * [[Hallucinations]] | ||
* Loss of consciousness | * Loss of consciousness | ||
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* [[Hepatitis]] | * [[Hepatitis]] | ||
* [[Hyperpyrexia]] | * [[Hyperpyrexia]] | ||
* [[Hyponatremia]] (SIADH) | *[[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> | ||
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Latest revision as of 20:10, 12 January 2021
Background
- 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
| System | Minor or moderate overdose | Severe overdose |
|---|---|---|
| Cardiovascular |
| |
| Central nervous system |
|
|
| Musculoskeletal |
| |
| Respiratory | ||
| Urinary | ||
| Other |
|
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
Evaluation
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 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
- ↑ 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