Must-read paper: 12 cases of MDMA (ecstasy) toxicity from a rave party
July 3, 2012, 1:18 am
Multiple MDMA (Ecstasy) Overdoses at a Rave Event: A Case Series. Armenian P et al. J Intensive Care Med 2012 May 28 [Epub ahead of print]
This remarkable case series describes 12 patients with severe MDMA (ecstasy) toxicity brought to San Francisco area hospitals from a single “rave” party at the Cow Palace in May 2010. Two of the 12 patients died, 8 required endotracheal intubation, 6 were hypotensive, and 10 were hyperthermic ( up to 109.4oF), and 5 were dialyzed for acute renal failure, hyperkalemia, or metabolic acidosis. All patients developed rhabdomyolysis during their hospital course.
Hypotension, hyperthermia, and hyperkalemia were associated with worse clinical outcomes. Of the 10 patients who survived, one required bilateral below-knee amputations for compartment syndrome and lower extremity necrosis, 2 had persistent cognitive impairment, and 1 was still on hemodialysis at time of hospital discharged.
Three patients had serum samples tested for drugs; MDMA was the only substance that was identified. Two drug specimens confiscated at the rave party were tested; these contained 82% and 98% MDMA, with one sample containing two or three times the usual MDMA dose. Despite initial speculation that the extensive and severe toxicity stemming from this event must have been due to “tainted” drugs, MDMA was the only substance identified.
The authors conclude that “MDMA-induced hyperthermia appears to be the common pathway for organ dysfunction in MDMA toxicity”. Cooling methods utilized in these cases included ice packs to the groin and axillae, cooling blankets, and antipyretics. Rapid cooling was associated with improved outcome.
This is a dramatic and unique paper, and an absolute must-read.
[To read my Emergency Medicine News column on MDMA (ecstasy), click here.]