MDMA (Ecstasy) Toxicity 

 

 

Considerations

 

  • Sequelae of MDMA overdose: 

    • Cardiovascular: hypertension, tachyarrhythmias

    • CNS: cerebral edema, seizures, anxiety 

    • Renal: acute hyponatremia, rhabdomyoloysis

    • Metabolic: hyperthermia

  • Risk of DIC & multi-organ failure leading to coagulopathy & impaired drug metabolism/secretion

  • Co-ingestions

  • Need for invasive monitoring & ICU admission

 

 

Treatment 

 

  • Admit to monitored setting 

  • Consult toxicology if needed 

  • Cancel any elective surgery 

  • Rx of sequelae: 

    • Hypertension 

      • Benzodiazepines as first line agent until BP normalized or patient sedated 

      • If benzodiazpines inadequate, use vasodilators such as NTG, NTP, or phentolamine

      • Beta blockers are contraindicated 

    • Seizures & agitation: use benzodiazepines 

    • Hyponatremia 

      • Usually mild & will resolve in 12-24 hrs with water restriction 

      • If severe (< 120): use hypertonic 3% NS 100cc boluses q10 min 

    • Hyperthermia: 

      • Severe (> 41ºC): immerse in ice bath 

      • Moderate: use cooling blankets, cool water mist, fanning