Ecstasy (MDMA) toxicity: Difference between revisions
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==Background== | |||
[[File:MDMA.png|thumbnail|MDMA]] | [[File:MDMA.png|thumbnail|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 | ||
* | *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 | *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== | ==Clinical Features== | ||
* | *Euphoria | ||
*[[ | *Agitation | ||
* | *Tachycardia, palpitations, hypertension | ||
* | |||
*[[ | {| class="wikitable" | ||
* | |- | ||
*[[ | ! System | ||
* | ! Minor or moderate overdose || Severe overdose | ||
*[[ | |- | ||
* | ! Cardiovascular | ||
*[[ | | | ||
|| | |||
* [[Disseminated intravascular coagulation]] | |||
* [[Intracranial hemorrhage]] | |||
* Severe [[hypertension]] or [[hypotension]] | |||
* Hypotensive bleeding | |||
|- | |||
! Central nervous<br />system | |||
| | |||
* Hyperreflexia | |||
* Agitation | |||
* Confusion | |||
* Paranoia | |||
* Stimulant psychosis | |||
| | |||
* Cognitive deficit | |||
* Coma | |||
* [[Seizure]] | |||
* [[Hallucinations]] | |||
* Loss of consciousness | |||
* [[Serotonin syndrome]] | |||
|- | |||
! Musculoskeletal | |||
| | |||
| | |||
* Hypertonia | |||
* [[Rhabdomyolysis]] | |||
|- | |||
! Respiratory | |||
| | |||
| | |||
* [[Acute respiratory distress syndrome]] | |||
|- | |||
! Urinary | |||
| | |||
| | |||
* [[Acute kidney injury]] | |||
|- | |||
! Other | |||
| | |||
| | |||
* Cerebral edema | |||
* [[Hepatitis]] | |||
* [[Hyperpyrexia]] | |||
*[[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> | *[[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> | ||
|} | |||
== | ==Differential Diagnosis== | ||
{{Sympathomimetic types}} | |||
{{Drugs of abuse types}} | |||
==Evaluation== | |||
{{Hallucinogen workup}} | {{Hallucinogen workup}} | ||
*Urine tox fails to detect unless large | *Urine tox fails to detect unless large doses | ||
**More usually positive test for amphetamines | **More usually positive test for amphetamines | ||
**Confirmation must use specialized lab tests (gas chromatography) | **Confirmation must use specialized lab tests (gas chromatography) | ||
==Management== | ==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== | ==Disposition== | ||
* | *Consider discharge if all symptoms resolve and no complications noted | ||
* | *Otherwise admit | ||
==References== | ==References== | ||
<references /> | <references/> | ||
==See Also== | ==See Also== |
Revision as of 05:34, 6 September 2019
Background
- 3,4-methylenedioxymethamphetamine (MDMA)
- Also known as: 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