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MDMA, 3,4-methylenedioxymetamphetamine,
"Ecstasy"/"E"/"XTC"
Clinical features
- tend to be admitted from party, concert or rave
- CNS features: agitation, coma, convulsions, muscle rigidity, hyperthermia,
sweating, dilated pupils, panic, paranoia, trismus, bruxism (grinding of teeth),
intracranial infarction and thrombosis, intracranial haemorrhage, cerebral
oedema
- CVS: tachycardia, ventricular arrhythmias, hypertension followed by
hypotension, spontaneous bleeding
- GI: jaundice, hepatomegaly, hepatic failure
- Renal: oliguria, myoglobinuria due to rhabdomyolysis
- Biochemistry: metabolic acidosis, hypoglycaemia, raised creatinine, K, CPK,
LFTs, hyponatraemia
- DIC
- fulminant syndrome can develop within hours so close observation is necessary
Management
- supportive care with attention to airway, breathing and circulation
- consider ICU admission in all but the mildest cases
- empty stomach and give activated charcoal
- agitation and fits: incremental doses of diazepam
- hyperthermia: needs to be treated urgently using cooling blankets, ice-packs,
infusion of cold saline and peritoneal dialysis using cold dialysate. Consider
using dantrolene: very successful in one (small) series. 1 mg/kg IV repeated to
a total dose of 10 mg/kg
- prophylaxis of acute renal failure from rhabdomyolysis. Take care not to
precipitate pulmonary oedema or worsen cerebral oedema with excessive fluid
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