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
