Ecstasy



Ecstasy December 20-11 - single tablet may cause significant overdose

3, 4-methylenedioxymethamphetamine (mdma)

  • Dose 30-150 mg/tablet
  • Toxicity - stimulation peripheral/central Α and ß adrenoceptors
  • Severe, fatal reactions following previously tolerated doses
  • Early deaths usually cardiac arrhythmias
  • Features - effects within 1 hour, Last 4-6 hours after 75-150 mg ( up to 48hrs after 100-300 mg)
  • High concentration tablets (image) in December 2011 - significant overdoses

Clinical features

Mild symptoms / signs

  • Nausea, Vomiting
  • Sweating, anxiety
  • Dizziness, drowsiness
  • chest/abdo pain
  • Myalgia, insomnia
  • Mydriasis, tremor
  • Tachycardia, mild hypertension
  • Ataxia, nystagmus
  • Slight pyrexia

Severe signs

  • Hypertonia
  • Hyperpyrexia (>39°c)
  • Initial hypertension
  • Later hypotension

Life threatening

  • Coma
  • Convulsions
  • Delirium
  • Rigidity
  • ARDS
  • Rhabdomyolysis
  • ARF
  • DIC
  • Hepatocellular necrosis

Management

  • Charcoal if within 1 hour
  • Observe all cases for 6 hrs

If Moderate

  • BP, ECG, Temp for 12 hrs
  • Diazepam for anxiety , agitation
  • β-blockers for tachycardia
  • Cooling & Dantrolene for >39°c

If severe

  • Consider intubation
  • Beware metabolic acidosis
  • Monitor clotting / renal fxn

Content by Dr Íomhar O' Sullivan 23/06/2001. Reviewed by Dr ÍOS 11/11/2003, 18/05/2005, 13/05/2007, 14/011/2008. Last review Dr. ÍOS 18/09/14.