Multiple MDMA (Ecstasy) overdoses at a rave event: a case series.
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.
Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, CA 93701, USA. patilarmenian@gmail.com
Patil
P
Armenian
Tanya M
TM
Mamantov
Ben T
BT
Tsutaoka
Roy R L
RR
Gerona
Eric F
EF
Silman
Alan H B
AH
Wu
Kent R
KR
Olson
D000328:Adult; D003422:Critical Care / Q000379:methods; D062787:Drug Overdose / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006213:Hallucinogens / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D012495:San Francisco / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
D006213:Hallucinogens; D018817:N-Methyl-3,4-methylenedioxyamphetamine