Ecstasy (MDMA) toxicity - Revision history

Rossdonaldson1: /* Background */

2021-01-12T20:10:30Z

Background

← Older revision		Revision as of 20:10, 12 January 2021
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	[[File:Ecstasy monogram.jpg\|thumb\|Ecstasy tablets containing MDMA]]		[[File:Ecstasy monogram.jpg\|thumb\|Ecstasy tablets containing MDMA]]
	*3,4-methylenedioxymethamphetamine (MDMA)		*3,4-methylenedioxymethamphetamine (MDMA)
	*Also known as: X, Molly, Skittles, Smartees, Beans		*Also known as: Ecstasy, X, Molly, Skittles, Smartees, Beans
	*Popular at "rave" parties and EDM festivals		*Popular at "rave" parties and EDM festivals
	*Causes catecholamine release, serotonin release, and inhibits serotonin re-uptake		*Causes catecholamine release, serotonin release, and inhibits serotonin re-uptake

Rossdonaldson1: /* Clinical Features */

2019-09-06T05:34:21Z

Clinical Features

← Older revision		Revision as of 05:34, 6 September 2019
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	*Agitation		*Agitation
	*Tachycardia, palpitations, hypertension		*Tachycardia, palpitations, hypertension
	*[[Hyperthermia]]
	*[[Hyponatremia]] (from sweat loss, free water intake, and SIADH-like effect) <ref>Aitchison KJ, Tsapakis EM, Huezo-Diaz P, Kerwin RW, Forsling ML, Wolff K. Ecstasy (MDMA)-induced hyponatraemia is associated with genetic variants in CYP2D6 and COMT. J Psychopharmacol. 2012;26(3):408-18</ref>
	*[[Seizure]]
	*[[Serotonin syndrome]]

	{\| class="wikitable"		{\| class="wikitable"
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	* Cognitive deficit		* Cognitive deficit
	* Coma		* Coma
	* ~~Convulsions~~		* [[Seizure]]
	* [[Hallucinations]]		* [[Hallucinations]]
	* Loss of consciousness		* Loss of consciousness
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	* [[Hepatitis]]		* [[Hepatitis]]
	* [[Hyperpyrexia]]		* [[Hyperpyrexia]]
	* [[Hyponatremia]] (SIADH)		*[[Hyponatremia]] (from sweat loss, free water intake, and SIADH-like effect) <ref>Aitchison KJ, Tsapakis EM, Huezo-Diaz P, Kerwin RW, Forsling ML, Wolff K. Ecstasy (MDMA)-induced hyponatraemia is associated with genetic variants in CYP2D6 and COMT. J Psychopharmacol. 2012;26(3):408-18</ref>
	\|}		\|}

Rossdonaldson1: /* Clinical Features */

2019-09-06T05:33:29Z

Clinical Features

@@ Line 17: / Line 17: @@
 *[[Seizure]]
 *[[Serotonin syndrome]]
 ==Differential Diagnosis==

Rossdonaldson1: /* Background */

2019-09-06T04:24:33Z

Background

← Older revision		Revision as of 04:24, 6 September 2019
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	==Background==		==Background==
	[[File:MDMA.png\|thumbnail\|MDMA]]		[[File:MDMA.png\|thumbnail\|MDMA]]
			[[File:Ecstasy monogram.jpg\|thumb\|Ecstasy tablets containing MDMA]]
	*3,4-methylenedioxymethamphetamine (MDMA)		*3,4-methylenedioxymethamphetamine (MDMA)
	*Also known as: X, Molly, Skittles, Smartees, Beans		*Also known as: X, Molly, Skittles, Smartees, Beans

Rossdonaldson1: /* Differential Diagnosis */

2019-09-06T04:22:12Z

Differential Diagnosis

← Older revision		Revision as of 04:22, 6 September 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Sympathomimetic types}}		{{Sympathomimetic types}}
			{{Drugs of abuse types}}

	==Evaluation==		==Evaluation==

Kxl328: /* Clinical Features */

2018-02-16T15:52:59Z

Clinical Features

← Older revision		Revision as of 15:52, 16 February 2018
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	*[[Hyponatremia]] (from sweat loss, free water intake, and SIADH-like effect) <ref>Aitchison KJ, Tsapakis EM, Huezo-Diaz P, Kerwin RW, Forsling ML, Wolff K. Ecstasy (MDMA)-induced hyponatraemia is associated with genetic variants in CYP2D6 and COMT. J Psychopharmacol. 2012;26(3):408-18</ref>		*[[Hyponatremia]] (from sweat loss, free water intake, and SIADH-like effect) <ref>Aitchison KJ, Tsapakis EM, Huezo-Diaz P, Kerwin RW, Forsling ML, Wolff K. Ecstasy (MDMA)-induced hyponatraemia is associated with genetic variants in CYP2D6 and COMT. J Psychopharmacol. 2012;26(3):408-18</ref>
	*[[Seizure]]		*[[Seizure]]
			*[[Serotonin syndrome]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: Rossdonaldson1 moved page Ecstasy (MDMA) to Ecstasy (MDMA) toxicity

2017-05-22T04:20:34Z

Rossdonaldson1 moved page Ecstasy (MDMA) to Ecstasy (MDMA) toxicity

← Older revision	Revision as of 04:20, 22 May 2017
(No difference)

Mholtz: Simplified management section

2017-05-10T02:21:03Z

Simplified management section

@@ Line 1: / Line 1: @@
 [[File:MDMA.png|thumbnail|MDMA]]
-==Background==
 *3,4-methylenedioxymethamphetamine (MDMA)
 *Also known as: X, Molly, Skittles, Smartees, Beans
@@ Line 10: / Line 11: @@
 ==Clinical Features==
 *Euphoria
 *Agitation
 *Tachycardia, palpitations, hypertension
 *[[Hyperthermia]]
 *[[Hyponatremia]] (from sweat loss, free water intake, and SIADH-like effect) <ref>Aitchison KJ, Tsapakis EM, Huezo-Diaz P, Kerwin RW, Forsling ML, Wolff K. Ecstasy (MDMA)-induced hyponatraemia is associated with genetic variants in CYP2D6 and COMT. J Psychopharmacol. 2012;26(3):408-18</ref>
 *[[Seizure]]
 ==Differential Diagnosis==
@@ Line 35: / Line 27: @@
 ==Management==
-===Prehospital===
+*Supportive care is mainstay of treatment
-*Primary focus should be on controlling agitation as well as ABCs
+*[[Benzodiazepines]] for agitation, severe hypertension
+*Hyperthermia may be severe and requires immediate treatment with active cooling measures
-===ABCs===
+**Morbidity/mortality is related to severity and length of hyperthermia
 ==Disposition==

Mholtz at 23:58, 9 May 2017

2017-05-09T23:58:43Z

← Older revision		Revision as of 23:58, 9 May 2017
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	==Background==		==Background==
	*3,4-methylenedioxymethamphetamine (MDMA)		*3,4-methylenedioxymethamphetamine (MDMA)
	*~~other names~~: E, X, ~~XTC~~, ~~Adam~~, ~~Stacy~~		*Also known as: X, Molly, Skittles, Smartees, Beans
	*~~causes~~ catecholamine release, serotonin release, and inhibits serotonin re-uptake		*Popular at "rave" parties and EDM festivals
	*"rave" parties		*Causes catecholamine release, serotonin release, and inhibits serotonin re-uptake
	*1-2mg/kg effective dose; onset 30min-1 hour, peak 4 hours, lasts 8-24 hours		*1-2mg/kg effective dose; onset 30min-1 hour, peak 4 hours, lasts 8-24 hours
	*~~typical~~ tablets;contain 50-100mg of ~~ecstatsy (although other substances possible)~~		**Typical tablets contain 50-100mg of MDMA

	==Clinical Features==		==Clinical Features==
	*~~Most people report euphoria~~		*Euphoria
	*[[altered mental status]]		*[[altered mental status]]
	*~~agitation~~		*Agitation
	*~~tachycardia~~, palpitations, hypertension		*Tachycardia, palpitations, hypertension
	*[[Serotonin Syndrome]] ([[altered mental status]], [[Hyperthermia]], rigidity, autonomic instability)		*[[Serotonin Syndrome]] ([[altered mental status]], [[Hyperthermia]], rigidity, autonomic instability)
	*rhabdomyolysis, myoglobinuria		*rhabdomyolysis, myoglobinuria
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	*Hepatotoxicity<ref>Carvalho M, Pontes H, Remiao F, Bastos ML, Carvalho F. Mechanisms underlying the hepatotoxic effects of ecstasy. Curr Pharm Biotechnol. 2010;11(5):476-95</ref>		*Hepatotoxicity<ref>Carvalho M, Pontes H, Remiao F, Bastos ML, Carvalho F. Mechanisms underlying the hepatotoxic effects of ecstasy. Curr Pharm Biotechnol. 2010;11(5):476-95</ref>

	==~~Workup~~==		==Differential Diagnosis==
			{{Sympathomimetic types}}

			==Evaluation==
	{{Hallucinogen workup}}		{{Hallucinogen workup}}
	*Urine tox fails to detect unless large ~~doeses~~		*Urine tox fails to detect unless large doses
	**More usually positive test for amphetamines		**More usually positive test for amphetamines
	**Confirmation must use specialized lab tests (gas chromatography)		**Confirmation must use specialized lab tests (gas chromatography)
	*[[Chest pain]] work up if applicable
	*Blood and urine cultures if signs of infection

	~~==Differential Diagnosis==~~
	~~{{Sympathomimetic types}}~~

	==Management==		==Management==
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	==Disposition==		==Disposition==
	*~~Admit patient's with~~ complications ~~of ingestion~~		*Consider discharge if all symptoms resolve and no complications noted
	*~~Discharge those who are asymptomatic and no life threatening complication~~		*Otherwise admit

	==References==		==References==
	<references />		<references/>

	==See Also==		==See Also==

Lisayee25: /* Agitation */

2017-05-06T15:42:34Z

Agitation

← Older revision		Revision as of 15:42, 6 May 2017
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	===Agitation===		===Agitation===
	**Sedation with [[Benzodiazepines]] as needed		*Sedation with [[Benzodiazepines]] as needed
	**Avoid Haldol, interferes with heat dissipation, may prolong QTc, may reduce seizure threshold		*Avoid Haldol, interferes with heat dissipation, may prolong QTc, may reduce seizure threshold

	===[[Seizure]]===		===[[Seizure]]===