Anesthesia Considerations 

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