Ecstasy (MDMA) toxicity
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