MDMA (exctasy) toxicity

Learning objectives

MDMA (3,4-methylenedioxymethamphetamine) ecstasy is a synthetic compound with structural and pharmacologic similarities to both amphetamines and mescaline
Typical effects include feelings of euphoria, wakefulness, intimacy, excitement, and a loss of inhibitions
It is mistakenly believed that it is a safe drug with little toxicity and a long duration of action
The effects of MDMA typically last anywhere from 3 to 6 hours
Effects are thought to result from alterations in serotonin, dopamine, and norepinephrine
The drug is commonly ingested orally in tablet form, however, the powder itself can be snorted
Absorbed via the GI tract with an onset of effect between 20 minutes and 1 hour after consumption
MDMA is profoundly serotonergic and can precipitate serotonin syndrome

Minor side effects	Life-threatening side effects
Trismus	Hyperpyrexia > 41.5°C
Tachycardia	Rhabdomyolysis
Bruxism	Serotonin syndrome
Anxiety	Acute liver failure
Prolonged hangover	Hyponatremia and cerebral edema

System	Minor or moderate overdose	Severe overdose
Cardiovascular		Disseminated Intravascular Coagulation (DIC) Intracranial hemorrhage Severe Hypotension or Hypertension Hypotensive bleeding
Central nervous system	Hyperreflexia Agitation Mental confusion Paranoia Stimulant psychosis	Cognitive and memory impairment potentially to the point of retrograde or anterograde amnesia Coma Convulsions Hallucinations Loss of consciousness Serotonin syndrome
Musculoskeletal		Muscle rigidity Rhabdomyolysis
Respiratory		Acute Respiratory Distress Syndrome
Urinary		Acute kidney injury (AKI)
Other		Cerebral edema Hepatitis Hyperpyrexia Hyponatremia

Neurological
- Delirium
- Seizures
Cardiovascular
- Cardiac dysrhythmias
- Myocardial infarction
- Aortic dissection
- Intracranial hemorrhages
GI
- Hepatotoxicity
- Liver failure
Renal
- Rhabdomyolysis
- Acute renal failure
Endocrine
- SIADH resulting in life-threatening hyponatremia
Minor complications
- Increased muscle activity (such as bruxism, restless legs, and jaw clenching)
- Hyperactivity
- Insomnia
- Difficulty concentrating
- Feelings of restlessness

Blood glucose levels
Electrolyte abnormalities
Urine, potassium, BUN, creatinine, creatine phosphokinase levels, and myoglobin levels for the evaluation of rhabdomyolysis and renal injury
LFTs for hepatotoxicity
Aspirin, alcohol, acetaminophen levels, and urine drug screening
ECG
Head CT, lumbar punction