MDMA Toxicity Workup

  • Author: In-Hei Hahn, MD, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Mar 9, 2011
 

Laboratory Studies

  • If a patient gives a clear history of MDMA ingestion with mild symptoms and is hemodynamically stable, no laboratory studies are indicated.
  • If the history is absent and/or questionable or if the patient exhibits signs of moderate-to-severe toxicity, appropriate laboratory studies include the following:
    • Obtain a CBC count to exclude infection as a cause of fever and altered mental status.
    • Measure electrolyte levels and pay particular attention to sodium and renal function.
    • A bedside glucose determination is always indicated in patients with altered mental status.
    • Obtain liver function tests (LFTs), prothrombin time, and/or activated partial thromboplastin time. Patients manifesting significant or prolonged hyperthermia require evaluation of hepatic and coagulation studies to exclude DIC.
    • Perform pregnancy tests in women of childbearing age.
    • A creatine kinase measurement is helpful to exclude rhabdomyolysis.
    • Dipstick urinalysis findings can be positive for myoglobinuria.
    • The urine toxicology screen fails to detect MDMA unless large doses have been ingested. It is nonspecific, and positive test findings only indicate presence of an amphetamine drug class. Confirmation by means of gas chromatography and/or mass spectrometry is strongly recommended when test findings are positive for amphetamines.
    • Patients complaining of chest pain should undergo electrocardiographic testing and monitoring. Include cardiac enzymes in laboratory studies for chest pain secondary to suspected ischemia.
    • In addition to the tests listed above, laboratory studies for altered mental status may include serum osmolality, alcohol, and ketones.
    • Send cultures of blood and urine for testing if signs of infection and fever are present. Consider lumbar puncture to exclude meningitis.
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Imaging Studies

  • Patients demonstrating only mild symptoms without any hemodynamic instability do not require imaging studies. Observation and supportive care is recommended.
  • Obtain a chest radiograph in patients complaining of chest pain, demonstrating low oxygen saturations, or experiencing respiratory distress.
  • Patients presenting with a seizure or prolonged mental status changes despite initial resuscitation should undergo cranial CT scan. Metabolic causes such as hyponatremia should be found quickly and corrected cautiously.
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Other Tests

  • Patients complaining of chest pain should undergo electrocardiographic testing and monitoring.
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Procedures

  • Patients complaining of persistent headache may require a head CT and a lumbar puncture to rule out a subarachnoid hemorrhage.
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Contributor Information and Disclosures
Author

In-Hei Hahn, MD, FACEP  Attending Physician, Department of Emergency Medicine, Danbury Hospital Center, Assistant Professor, Department of Surgery, University of Vermont; St Lukes-Roosevelt Hospital Center; and Danbury Hospital Center; Assistant Clinical Professor, Department of Medicine, Columbia University College of Physicians and Surgeons.

In-Hei Hahn, MD, FACEP is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

Peter MC DeBlieux, MD  Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University School of Medicine in New Orleans

Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John G Benitez, MD, MPH  Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author David Yew, MD, to the original writing and development of this article.

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