title: A Case of 3,4-Dimethoxyamphetamine (3,4-DMA) and 3,4-Methylenedioxymethamphetamine (MDMA) Toxicity with Possible Metabolic Interaction.
abstract: We present a case of "ecstasy" ingestion revealing 3,4-methylenedioxymethamphetamine (MDMA) and 3,4-dimethoxyamphetamine (3,4-DMA) and absence of cytochrome P450 (CYP)-2D6 MDMA metabolites.
  
  
  
  A 19-year-old presented following a seizure. Initial vital signs were normal. Laboratories were normal with the exception of sodium 127 mEq/L and urine drugs of abuse screen positive for amphetamines. Twelve hours later, serum sodium was 114 mEq/L and a second seizure occurred. After receiving hypertonic saline (3%), the patient had improvement in mental status and admitted to taking "ecstasy" at a rave prior to her initial presentation. Liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS) of serum and urine revealed MDMA, 3,4-DMA, and the CYP-2B6 MDMA metabolites 3,4-methylendioxyamphetamine (MDA) and 4-hydroxy-3-methoxyamphetamine (HMA). The CYP2D6 metabolites of MDMA, 3,4-dihydromethamphetamine (HHMA) and 4-hydroxy-3-methoxymethamphetamine (HMMA), were detected at very low levels.
  
  
  
  This case highlights the polypharmacy which may exist among users of psychoactive illicit substances and demonstrates that concurrent use of MDMA and 3,4-DMA may predispose patients to severe toxicity. Toxicologists and other healthcare providers should be aware of this potential toxicity.
authors.affiliation: a Assistant Professor, Fresno Medical Education Program, Department of Emergency Medicine, Division of Medical Toxicology , University of California San Francisco , Fresno , CA , USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Darracq
authors.affiliation: b Assistant Professor, Department of Emergency Medicine, Kansas Poison Control System , University of Kansas Medical Center , Kansas City , KS , USA.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Thornton
authors.affiliation: c Assistant Professor, Department of Emergency Medicine, Division of Toxicology , University of California San Diego , San Diego , CA , USA.
authors.forename: Alicia B
authors.initials: AB
authors.lastname: Minns
authors.affiliation: d Assistant Professor, Department of Laboratory Medicine , University of California San Francisco , San Francisco , CA , USA.
authors.forename: Roy R
authors.initials: RR
authors.lastname: Gerona
mesh_terms: D015104:3,4-Methylenedioxyamphetamine / Q000378:metabolism; D000662:Amphetamines / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity*; D002853:Chromatography, Liquid / Q000379:methods; D004298:Dopamine / Q000031:analogs & derivatives / Q000378:metabolism; D004347:Drug Interactions; D005260:Female; D006213:Hallucinogens / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity*; D006801:Humans; D013058:Mass Spectrometry / Q000379:methods; D008694:Methamphetamine / Q000031:analogs & derivatives / Q000378:metabolism; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity*; D012640:Seizures / Q000139:chemically induced*; D015813:Substance Abuse Detection / Q000379:methods; D055815:Young Adult
chemical_list: D000662:Amphetamines; D006213:Hallucinogens; C079646:4-hydroxy-3-methoxymethamphetamine; C014500:3,4-dimethoxyamphetamine; C031105:3-O-methyl-alpha-methyldopamine; D008694:Methamphetamine; D015104:3,4-Methylenedioxyamphetamine; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D004298:Dopamine
keywords: 3,4 dimethoxyamphetamine (DMA); 3,4-methylenedioxymethamphetamine; liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS); pharmacokinetics