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[Hyperpyrexia and rhabdomyolysis after ecstasy (MDMA) intoxication]

O Kunitz1, A Ince, R Kuhlen

  • 1Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen. okunitz@ukaachen.de

Der Anaesthesist
|July 2, 2003
PubMed

Insights

This case study details a severe 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) overdose. Effective treatment involved dantrolene for hyperpyrexia and supportive care for multi-organ failure.

Area of Science:

  • Toxicology
  • Emergency Medicine
  • Pharmacology

Background:

  • 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) abuse is increasing, leading to severe complications.
  • Reported severe complications include hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulation (DIC), and organ failure.

Observation:

  • A 21-year-old male presented with a suicidal overdose of MDMA.
  • He developed severe hyperpyrexia (>43°C), rhabdomyolysis (myoglobin 88,000 µg/l), DIC, and early renal and liver failure.

Findings:

  • Intravenous dantrolene (140 mg) and cooling effectively treated hyperpyrexia.
  • Aggressive intravenous fluid therapy (5 L/day) supported renal function, increasing elimination of myoglobin, urea, and creatinine, avoiding hemodialysis.
  • Disseminated intravascular coagulation (DIC) was managed with antithrombin III, fresh frozen plasma, prothrombin complex concentrates, and aprotinin.

Implications:

  • This case highlights the potential severity of MDMA overdose and the effectiveness of specific treatments.
  • Prompt recognition and management of hyperpyrexia, rhabdomyolysis, DIC, and organ dysfunction are crucial for patient survival.
  • Aggressive supportive care, including dantrolene and fluid management, can prevent the need for intensive interventions like hemodialysis.

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