Acute medical problems due to Ecstasy use. Case-series of emergency department visits.

Ecstasy (MDMA) toxicity often involves multiple substances, complicating the clinical picture. Among 52 patients presenting to an emergency department, most had also consumed alcohol (51.9%) or other illicit drugs (71.1%). Common reasons for seeking care were collapse or loss of consciousness (36.5%), palpitations (19.2%), dizziness or weakness (15.4%), and anxiety (13.5%). Co-use of cocaine was linked to panic reactions (30.7% vs. 7.7% without cocaine). Deep coma occurred in 68.8% of patients who also used GHB or opiates, but in none who took Ecstasy alone. Severe complications included cardiac arrest, hyperthermia, rhabdomyolysis, and one death.

Study at a glance

Abstract

STUDY AIM: To describe the clinical characteristics of Ecstasy (3,4-Methylenedioxymethamphetamine, MDMA) toxicity. METHODS: Retrospective case-study of 52 self-reported Ecstasy intoxications presenting to our Emergency Department (ED) between January 2001 and December 2003. RESULTS: Most patients ingested Ecstasy together with other substances, including alcohol (51.9%) or other illicit drugs (71.1%). Medical problems leading to ED presentation were collapse or loss of consciousness (36.5%), palpitations (19.2%), dizziness or weakness (15.4%), and anxiety (13.5%). When other drugs were used in combination with Ecstasy the clinical presentation significantly changed. Panic reactions were observed in 4 of 13 patients with cocaine co-use (30.7%), compared to 3 of 39 patients without cocaine use (7.7%). Deep coma was found in 11 of 16 patients with co-use of gamma-hydroxybutyrate (GHB) or opiates (68.8%) but in none of the 36 patients who took Ecstasy without these drugs. Most patients were monitored in the ED. Six patients (11.5%) were transferred to an intensive care unit. Medical complications were severe in five patients and included cardiac arrest, hyperthermia, rhabdomyolysis, disseminated intravascular coagulation, renal insufficiency and liver failure, seizures, and one fatal outcome. CONCLUSIONS: The clinical picture of Ecstasy related problems is complicated by multiple drug ingestion. Co-use of cocaine induces panic reactions. Co-use of GHB or opiates results in depressed levels of consciousness.