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Ecstasy (MDMA)
From WikEM
(Redirected from Ecstasy)
Contents
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
- Hyperthermia
- Hyponatremia (from sweat loss, free water intake, and SIADH-like effect) [1]
- Seizure
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Evaluation
- 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
