MDMA (3,4-methylenedioxymethamphetamine) Toxicity

 

Substance:

MDMA (3,4-methylenedioxymethamphetamine), commonly known as Ecstasy, is a derivative of amphetamine and classified as a Schedule II drug. It stimulates the sympathetic nervous system and provides euphoria similar to cocaine and amphetamine [1, 2, 3].

 

Common Name:

Ecstasy, Molly, Adam, Eve, "Happy Pill," and "E."搖頭丸

 

Involving System:

 

Central Nervous System (CNS): altered mental status, seizure, coma. [4]

Cardiovascular System: tachycardia, hypertension, shock [1, 2, 3, 5, 6].

Renal System: acute kidney injury, hyponatremia [2, 3, 4, 5, 6, 7]

Muscular System: rhabdomyolysis [4, 8] 

 

Presentation:

 

Physiological effects: Anxiety, agitation, hyperthermia, tachycardia, sweating, hypertension, hyponatremia, rhabdomyolysis, acute kidney injury, hepatotoxicity, coagulopathy, seizures, electrolyte imbalances, and shock. [3, 5, 8]

 

Complications: Approximately 30% of cases may present with rhabdomyolysis, and 13% may progress to acute kidney injury. [8]

 

Additional risks include brain edema, intracranial hemorrhage, pulmonary edema, and multiple organ failure. [1, 6]

 

Chronic use effects: Long-term use may result in memory impairment, serotonin neuron damage, mood swings, insomnia, appetite loss, and addiction potential. [9, 10]

 

Antidote and Treatment: [11, 12, and 13]

 

Supportive care is the primary treatment, as there is no specific antidote for MDMA.

Gastrointestinal decontamination with gastric lavage within one hour, activated charcoal administration.

Airway management and oxygen support, rehydration, electrolyte balancing.

Sedation with benzodiazepines (e.g., diazepam at 0.1–0.3 mg/kg orally or intravenously) for agitation.

Seizure management using diazepam.

Hyponatremia management via fluid restriction or hypertonic saline for severe cases.

Metabolic acidosis correction with sodium bicarbonate.

Severe hypertension treatment with labetalol if indicated.

Hyperthermia management with dantrolene if body temperature exceeds 39°C, along with other cooling measures.

Mechanical ventilation may be required for patients with altered consciousness, along with treatment for potential multiple organ failure.

 

Disposition:

Close monitoring is essential, especially for patients with complications like rhabdomyolysis, renal injury, or serotonin syndrome. Admission to the ICU is recommended in severe cases. [20]

 

References

 

 

1. Kahn DE, Ferraro N, Benveniste RJ. 3 cases of primary intracranial hemorrhage associated with  "Molly", a purified form of 3,4-methylenedioxymethamphetamine (MDMA). J Neurol Sci. 2012 ;323(1-2):257-60.

 

2. Diffley M, Armenian P, Gerona R, Reinhartz O, Avasarala K. Catecholaminergic polymorphic ventricular tachycardia found in an adolescent after a methylenedioxymethamphetamine and marijuana-induced cardiac arrest. Crit Care Med. 2012 ;40(7):2223-6.

 

3.Grunau BE, Wiens MO, Brubacher JR. Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review. CJEM. 2010 ;12(5):435-42.

 

4.Devlin RJ, Henry JA. Clinical review: Major consequences of illicit drug consumption. Crit Care. 2008;12(1):202.

 

5.Mohamed WM, Ben Hamida S, Cassel JC, de Vasconcelos AP, Jones BC. MDMA: interactions with other psychoactive drugs. Pharmacol Biochem Behav. 2011 ;99(4):759-74.

 

6.Kaye S, Darke S, Duflou J. Methylenedioxymethamphetamine (MDMA)-related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology. Drug Alcohol Depend. 2009 ;104(3):254-61.

 

7.Salathe C, Blanc AL, Tagan D. SIADH and water intoxication related to ecstasy. BMJ Case Rep. 2018 Aug 29;2018:bcr2018224731. doi: 10.1136/bcr-2018-224731. PMID: 30158258; PMCID: PMC6119400.

 

8. Yu CH, Huang LC, Su YJ. Poisoning-Induced Acute Kidney Injury: A Review. Medicina (Kaunas). 2024 Aug 12;60(8):1302. doi: 10.3390/medicina60081302. PMID: 39202583; PMCID: PMC11356116.

 

9. McCann UD, Ricaurte GA. Effects of (+/-) 3,4-methylenedioxymethamphetamine (MDMA) on sleep and circadian rhythms. ScientificWorldJournal. 2007 Nov 2;7:231-8. Review.

 

10.Hui T, Guo S. Early onset Parkinson's disease in the cycle of 3,4-methylenedioxymethamphetamine and substance use: a case report. J Med Case Rep. 2023 Sep 23;17(1):405. doi: 10.1186/s13256-023-04147-x. PMID: 37740189; PMCID: PMC10517548.

 

11. Grunau BE, Wiens MO, Greidanus M. Dantrolene for the treatment of MDMA toxicity. CJEM. 2010 ;12(5):457-9.

 

12.Moon J, Cros J.  Role of dantrolene in the management of the acute toxic effects of Ecstasy (MDMA). Br J Anaesth. 2007 ;99(1):146.

 

13.Hall AP, Henry JA. Acute toxic effects of 'Ecstasy' (MDMA) and related compounds: overview of pathophysiology and clinical management. Br J Anaesth. 2006 Jun;96(6):678-85. doi: 10.1093/bja/ael078. Epub 2006 Apr 4. PMID: 16595612.

 

Edited by Yu-Jang Su, Nov 5, 2024