Multiple MDMA (Ecstasy) Overdoses at a Rave Event

Abstract

Twelve patients with 3,4-methylenedioxymethamphetamine (MDMA) toxicity from a single rave event presented to multiple San Francisco Bay area hospitals with various life-threatening complications including seizures and hyperthermia. Eight required emergent endotracheal intubation and six had hypotension. Hyperkalemia, acute kidney injury, and rhabdomyolysis were present in most of the patients. In all, 2 patients died, 4 survived with permanent neurologic, musculoskeletal, and/or renal sequelae, and 6 survived without any apparent lasting deficits. Hyperthermia was present in 10 patients and was severe (40.9-43° C) in 7. Using multiple cooling methods, the average time to achieve cooling was 2.7 hours. Serum drug analysis was performed on 3 patients, demonstrating toxic MDMA concentrations without the presence of other xenobiotics. Two capsules confiscated by police at the event contained 82% and 98% MDMA, respectively, without other pharmacologically active compounds. Capsule #2 contained 270 mg MDMA, which is more than twice the amount of MDMA usually contained in 1 dose. The MDMA-induced hyperthermia significantly contributed to the morbidity and mortality in this case series. Factors contributing to the severity of the hyperthermia include ingestion of large doses of MDMA, a warm ambient environment, and physical exertion.

State-dependent and environmental modulation of brain hyperthermic effects of psychoactive drugs of abuse

“…First, monkeys, which are much closer evolutionarily to humans show robust physiological changes in brain temperature similar to the range observed in rats 3,5,6 . Second, humans show pathological hyperthermia (>40-41°C) during acute intoxication by METH or MDMA, 19-22 also similar to the range seen in rats. Finally, direct measurements from healthy human volunteers suggest that brain temperatures (assessed by venous outflow) could reach 39.5-40.0°C during a 30-min bicycle exercise when they are wearing water-impermeable clothing 23-24 that impaired normal heat dissipation to the external environment.…”

Mechanisms and environmental factors that underlying the intensification of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy)-induced serotonin syndrome in rats

“…Thirdly, there is a clear gap between basic research and clinical practice. For instance, although excessive 5HT is the cause of the syndrome as demonstrated by fundamental research studies, drugs typically used for treating MDMA toxicity in patients are non-serotonergic (Armenian et al, 2013; Davies et al, 2014). How non-serotonergic mechanisms are involved in the pathways mediating serotonin syndrome is not understood and requires elucidation.…”

Rapidly reversible multiorgan failure after ingestion of “Molly” (pure 3,4-methylenedioxymethamphetamine): a case report

“…The mechanism of cardiac toxicity is not clearly understood but can be related to oxidative stress from toxic metabolites of MDMA [5,6]. In addition, other toxic effects include hyponatremia, disseminated intravascular coagulation, liver failure and cerebrovascular accidents [7,8]. The development of hyponatremia is multifactorial and is thought to be primarily due to drug-induced excessive thirst and secretion of arginine vasopressin in the setting of fluid availability [6].…”