Friday, July 13, 2012

MDMA ... Mega Dose Mortality Always

This Poison Review article shows us that a nice little lick of E can feel good and get you HOT, not in the sexual way.  Hyperthermia and eventually rhabdo, sepsis, DIC, renal failure and all kinds of fun complications killed several and destroyed several other lives after a night of raving to laser light fist pump music. Sad.

Most complications were secondary to high ambient temperatures, and prolonged dancing exacerbated by complicated serotonin/dopamine/norepi interactions driving high core body temperatures and increased muscle activity. The hyperthermia is what did the damage, unfortunately and as usual, simple supportive and cooling treatments were the only help.

"Cooling methods in the ED are either active or passive. Passive treatment includes ice pack application to neck, groin, and axillae and evaporative cooling. Immersion in ice water (1-3 degC) and evaporative cooling show equal efficacy.13 How- ever, ice water immersion is often impractical in the setting of a critically ill patient who requires monitoring as well as IV placement, ventilation, and resuscitation. Other methods reported include ice water lavage via nasogastric (NG) tube, chilled IV fluids, electronic cooling blankets, and neuromuscu- lar paralysis. These are not uniformly more effective than the previously mentioned methods but can be utilized as adjunct modalities.13 Although dantrolene was not specifically recom- mended by poison center staff, it was used in the management of 3 patients in this series. In 1 case report, it has been reported to control muscle hyperactivity in the setting of MDMA- induced hyperthermia."

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