title: Importance of early identification of methylenedioxymethamphetamine ('ecstasy') ingestion in victims of motor vehicle accidents.
abstract: The blood of motor vehicle accident victims is routinely screened upon their arrival at the emergency services mainly for alcohol, unless the suspicion of a specific compound arises. Two young men who sustained severe internal and orthopaedic injuries after a motor vehicle accident are described. The conscious patient denied their having used stupefacients, but toxicological analysis upon arrival at the operating room detected methylenedioxymethamphetamine, the metabolite methylenedioxyamphetamine and methamphetamine in their blood and urine specimens. Methylenedioxymethamphetamine concentrations in the clotted blood and in the urine ranged between 0.9-1.15 and 55-70 mg/l, respectively. Methylenedioxyamphetamine concentrations for both patients were less than 0.2 mg/l in the blood and 2.0-3.0 mg/l in the urine. Each had a blood methamphetamine concentration greater than 250 ng/ml. There was no trace of alcohol. Three days after their arrival at the hospital, acute liver insufficiency and mild rhabdomyolysis (serum glutamate-pyruvate transaminase/serum glutamic-oxaloacetic transaminase 1245/218 mU/ml, creatine phosphokinase 48 000 U/ml, respectively) were diagnosed in both patients. Appropriate treatment was administered in an intensive care area and both were discharged home several weeks later without sequelae. These findings suggest that in this era of the widespread abuse of 'ecstasy', concentrations of methylenedioxymethamphetamine, methylenedioxyamphetamine or metamphetamine should be sought routinely in motor vehicle accident victims admitted to emergency services with an altered state of consciousness so that the early monitoring of the potential development of organ pathology can be implemented.
authors.affiliation: Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Israel. draviw@tasmc.health.gov.il
authors.forename: Avi A
authors.initials: AA
authors.lastname: Weinbroum
mesh_terms: D000063:Accidents, Traffic; D000284:Administration, Oral; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000175:diagnosis*; D001774:Blood Chemical Analysis / Q000379:methods; D001930:Brain Injuries / Q000175:diagnosis; D003937:Diagnosis, Differential; D006213:Hallucinogens / Q000008:administration & dosage / Q000032:analysis*; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis* / Q000628:therapy; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000008:administration & dosage / Q000032:analysis*; D012894:Sleep Stages; D015813:Substance Abuse Detection / Q000379:methods*; D016482:Urinalysis / Q000379:methods
chemical_list: D006213:Hallucinogens; D018817:N-Methyl-3,4-methylenedioxyamphetamine