MDMA Toxicity Follow-up

Updated: Dec 16, 2016
  • Author: In-Hei Hahn, MD, FACEP, FACMT; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Follow-up

Further Outpatient Care

Refer the patient for drug abuse counseling and treatment.

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Further Inpatient Care

Admission to an intensive care unit may be needed in patients with any of the following:

  • Significant hyperthermia
  • Altered mental status
  • Seizures
  • Severe hyponatremia
  • Respiratory depression
  • Acute renal failure secondary to rhabdomyolysis
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Transfer

Patients may require transfer to a psychiatric facility for evaluation and treatment if they exhibit dangerous behavior or psychosis refractory to general supportive measures. However, patients must be stable, without hemodynamic instability and with no evidence of cardiac, cerebral, renal, hepatic, or pulmonary complications.

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Complications

Hyperthermia and the risk of serotonin syndrome can result in increased mortality with complications of disseminated intravascular coagulation, rhabdomyolysis, and acute kidney injury. Institute general cooling measures and treat rhabdomyolysis with generous intravenous hydration and alkalinization of the urine.

Monitor hyponatremia as a result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and excessive water intake for resultant cerebral edema and seizures. In severe cases, administration of 3% saline and furosemide may be indicated to correct the hyponatremia, but at a rate no greater than 0.5-1 mEq/L/h.

As with any amphetamine, the risk of stroke, cardiac arrhythmia, and heart failure always is possible. The risk is especially high in patients with congenital abnormalities (eg, arteriovenous malformations, cardiomyopathy) or underlying heart and pulmonary disease.

Although the causal relationship between MDMA and liver toxicity has not been shown definitively, case reports document hepatotoxicity resulting in self-limited hepatitis and fulminant liver failure following MDMA use.

Always keep in mind the possibility of other drug ingestions. MDMA users often co-ingest other drugs, and ecstasy tablets can also contain other drugs. Heroin, ketamine, cocaine, alcohol, and marijuana have been implicated, and the patient may present with a mixed toxidromic clinical picture.

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Patient Education

Patient education is essential in communicating the short- and long-term risks of MDMA use. MDMA long has been misperceived as a safe drug with few adverse effects and a long duration of action. However, tolerance develops quickly, and users who respond by taking larger doses place themselves further at risk for complications of sympathetic hyperactivity leading to possible cardiac arrhythmias, hyperthermia, and hemodynamic instability.

Patients must also be informed of long-term psychiatric implications associated with regular use. Depression, anxiety, paranoia, and insomnia have been reported to last for years after cessation of MDMA use. In addition, studies have demonstrated impairment in concentration and memory associated with MDMA use.

For patient education information, see the First Aid and Injuries Center and Mental Health Center, as well as Club Drugs, Drug Dependence & Abuse, Substance Abuse, Poisoning, and Activated Charcoal.

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