MDMA Toxicity Workup

Updated: Jan 25, 2023
  • Author: In-Hei Hahn, MD, FACEP, FACMT; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Approach Considerations

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 complete blood cell count (CBC) 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 hepatic and coagulation studies to exclude disseminated intravascular coagulation (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.
  • In addition to the tests listed above, laboratory studies for altered mental status may include serum osmolality, alcohol, and ketones.

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.

Send cultures of blood and urine for testing if signs of infection and fever are present. Consider lumbar puncture to exclude meningitis.


Imaging Studies

Patients with 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.  Patients complaining of persistent headache may require a cranial CT scan.