Difference between revisions of "Ecstasy (MDMA) toxicity"

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===Agitation===
 
===Agitation===
**Sedation with [[Benzodiazepines]] as needed
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*Sedation with [[Benzodiazepines]] as needed
**Avoid Haldol, interferes with heat dissipation, may prolong QTc, may reduce seizure threshold
+
*Avoid Haldol, interferes with heat dissipation, may prolong QTc, may reduce seizure threshold
  
 
===[[Seizure]]===
 
===[[Seizure]]===

Revision as of 15:42, 6 May 2017

MDMA

Background

  • 3,4-methylenedioxymethamphetamine (MDMA)
  • other names: E, X, XTC, Adam, Stacy
  • causes catecholamine release, serotonin release, and inhibits serotonin re-uptake
  • "rave" parties
  • 1-2mg/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

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
    • More usually positive test for amphetamines
    • Confirmation must use specialized lab tests (gas chromatography)
  • Chest pain work up if applicable
  • Blood and urine cultures if signs of infection

Differential Diagnosis

Sympathomimetics

Management

Prehospital

  • Primary focus should be on controlling agitation as well as ABCs

ABCs

  • IV, O2, monitor
  • Airway: Intubate if necessary
  • Breathing: not expected to cause hypoxia, consider other dx or concurrent problem (aspiration PNA)
  • Circulation: severe hypertension
    • benzodiazepines first line
    • Consider nitroprusside or phentolamine, avoid beta blockers (unopposed alpha stimulation)

Agitation

  • Sedation with Benzodiazepines as needed
  • Avoid Haldol, interferes with heat dissipation, may prolong QTc, may reduce seizure threshold

Seizure

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

Gastrointestinal decontamination

  • Activated charcoal for recent ingestion (< 1 hour)
  • Patient must be protecting airway or intubated

Disposition

  • Admit patient's with complications of ingestion
  • Discharge those who are asymptomatic and no life threatening complication

References

  1. 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
  2. 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

See Also