MDMA overdose

Q: 23 year old male is admitted to ICU after attending all night "circuit party" on new year's eve. Intoxication with 3,4-methylenedioxymethamphetamine (MDMA) is highly suspected. Patient starts having seizures in ICU and required intubation for the protection of airway. Patient is found to be hyperthermic at 41°C. Serum sodium is reported as 114 mEq/dL. All of the following can be administrated except?

A)  Benzodiazepines 
B) Activated charcoal 
C) Phenytoin 
D) 3% (hypertonic) saline 
E) Active external cooling


Answer:  C

MDMA, popularly known as 'Ecstasy' is a dangerous drug. It is a common drug used for "raves" or "circuit parties". Benzodiazepine is the mainstay of treatment.  Following drugs should be avoided, though clinicians may tend to use them.

• haloperidol 
• phenytoin 
• beta-blockers 
• antipyretics

Haldol may decrease the seizure threshold, interfere with heat dissipation, as well as may prolong the QTc interval. Pure beta-blockers may cause unopposed alpha-adrenergic stimulation. Seizure in MDMA intoxication is mostly due to hyponatremia and do not respond to phenytoin. Similarly, hyperthermia does not respond to antipyretics and may require active cooling.

#toxicology
#electrolyteimbalance
#neurology


References:

Kalant H. The pharmacology and toxicology of "ecstasy" (MDMA) and related drugs. CMAJ 2001; 165:917. 

Armenian P, Mamantov TM, Tsutaoka BT, et al. Multiple MDMA (Ecstasy) overdoses at a rave event: a case series. J Intensive Care Med 2013; 28:252.