BOF:
33
A 27
year old female is brought in to casualty by her friends. They had been at a
nightclub and they noticed that she has become very restless and anxious and
had felt that people in the nightclub were trying to attack her
The
friends were not aware of any illicit drug use by the patient and she does not
give a coherent history
You
begin to examine the patient
Which
one of the following signs would suggest the patient has used Ecstasy
methylenedioxymethamphetamine (MDMA)
Answer: e)
3,
4-methylenedioxymethamphetamine (MDMA, ecstasy)
ü
MDMA
amphetamine derivative
ü
Structurally similar to methamphetamine and the hallucinogen mescaline
ü
Causes
catecholamine release from presynaptic vesicles
ü
Also a
selective serotonergic neurotoxin that causes massive release of serotonin ,
5-hydroxytryptamine (5-HT) and is postulated to inhibit its uptake
MDMA toxicity
ü
Seizures
ü
Hyperthermia
ü
Coagulopathies
ü
Arrhythmias
ü
Heart
failure
ü
Stroke,
ü
Renal
and or liver failure
ü
Most
MDMA-related fatalities attributed to symptoms of heat stroke and hyperthermia
ü
Another major cause of morbidity and mortality is abnormal fluid, electrolyte
balance, or both
•
MDMA
stimulates vasopressin release, resulting in SIADH
•
In
conjunction with too much water intake during profuse sweating and salt loss
can lead to severe hyponatraemia with subsequent cerebral oedema and seizures.
ü
Although uncommon arrhythmias heart failure occur
ü
MDMA-induced myocardial infarction is rarely reported.
ü
Intracerebral haemorrhage uncommon
Revision Tip
Revise
delirium KEYS to SUCCESS in Medicine page
430-432
