MDMA

MAMA

Up Cocaine Ketamine LSD MDMA Phencyclidine

Asian Intensive Care Research Meeting, November 4th-5th, Hong Kong




MDMA, 3,4-methylenedioxymetamphetamine, "Ecstasy"/"E"/"XTC"
Clinical features

* tend to be admitted from party, concert or rave
* CNS features: agitation, coma, convulsions, muscle rigidity, hyperthermia, sweating, dilated pupils, panic, paranoia, trismus, bruxism (grinding of teeth), intracranial infarction and thrombosis, intracranial haemorrhage, cerebral oedema
* CVS: tachycardia, ventricular arrhythmias, hypertension followed by hypotension, spontaneous bleeding
* GI: jaundice, hepatomegaly, hepatic failure
* Renal: oliguria, myoglobinuria due to rhabdomyolysis
* Biochemistry: metabolic acidosis, hypoglycaemia, raised creatinine, K, CPK, LFTs, hyponatraemia
* DIC
* fulminant syndrome can develop within hours so close observation is necessary

Management

* supportive care with attention to airway, breathing and circulation
* consider ICU admission in all but the mildest cases
* empty stomach and give activated charcoal
* agitation and fits: incremental doses of diazepam
* hyperthermia: needs to be treated urgently using cooling blankets, ice-packs, infusion of cold saline and peritoneal dialysis using cold dialysate. Consider using dantrolene: very successful in one (small) series. 1 mg/kg IV repeated to a total dose of 10 mg/kg
* prophylaxis of acute renal failure from rhabdomyolysis. Take care not to precipitate pulmonary oedema or worsen cerebral oedema with excessive fluid loading