[Hyperpyrexia and rhabdomyolysis after ecstasy (MDMA) intoxication].
Abuse of 3,4-methylenedioxymethamphetamine (MDMA,Ecstasy) is still growing over the last years and reports of severe or even fatal complications, such as arrhythmias, hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulopathy (DIC), acute renal or liver failure or brain oedema are also increasing. We report the case of a 21-year-old male who took a suicidal overdose of MDMA and subsequently developed severe hyperpyrexia (>43 degrees C/109.4 degrees F), rhabdomyolysis with an initial myoglobin level of 88,000 microg/l, disseminated intravascular coagulation (DIC) and beginning renal and liver failure. Infusing dantrolene 140 mg (2.5 mg/kg body weight) i.v. and using supportive cooling was effective in treating hyperpyrexia. To support renal function and diuresis we increased the intravenous fluid supply up to 5 l per day which led to a raised elimination of myoglobin, urea nitrogen and creatinine within 1 week. Hemodialysis was not necessary. DIC was treated according to laboratory parameters by supply of antithrombin (AT) III, fresh frozen plasma, prothrombin complex concentrates (PPSB) and continuous aprotinin 100,000 IE/h.
Kunitz
O
O
Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen. okunitz@ukaachen.de
Ince
A
A
Kuhlen
R
R
Rossaint
R
R
D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced; D004231:Diuresis; D005334:Fever / Q000139:chemically induced* / Q000503:physiopathology; D006213:Hallucinogens / Q000506:poisoning*; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000506:poisoning*; D010949:Plasma; D011516:Prothrombin / Q000627:therapeutic use; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000503:physiopathology; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use; D013406:Suicide, Attempted
D006213:Hallucinogens; D015842:Serine Proteinase Inhibitors; D011516:Prothrombin; D018817:N-Methyl-3,4-methylenedioxyamphetamine