Ecstasy
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
- Consider charcoal if within 1 hour
- Observe all cases for 6 hrs
Mx Moderate
- BP, ECG, Temp for 12 hrs
- Diazepam for anxiety , agitation
- β-blockers for tachycardia
- Cooling & Dantrolene for >39°c
Mx severe
- Consider intubation
- Beware metabolic acidosis
- Monitor clotting / renal fxn
Content by Dr Íomhar O' Sullivan 23/06/2001. Reviewed by Dr ÍOS. Last review Dr ÍOS 22/10/22.