What is the mortality and morbidity associated with MDMA toxicity?

Updated: May 30, 2020
  • Author: In-Hei Hahn, MD, FACEP, FACMT; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

MDMA toxicity has been associated with the following:

  • Seizures
  • Hyperthermia
  • Coagulopathies
  • Arrhythmias
  • Heart failure
  • Stroke
  • Renal failure
  • Liver failure

Most MDMA-related fatalities have been attributed to symptoms of heat stroke and hyperthermia. Many of these patients exhibited features of the serotonin syndrome. Hyperthermia results from the catecholamine surge caused by MDMA and is exacerbated in the setting of raves. Increased body temperatures with vigorous dancing in crowded hot clubs can cause dehydration, DIC, rhabdomyolysis, and acute renal failure. MDMA users are informed at raves to stay adequately hydrated and take cooling measures as needed.

Studies in rats have shown that high ambient temperatures enhance MDMA-induced locomotor activity, suggesting that the high temperatures seen at raves may serve as an incentive to users to prolong and enhance their "high." [24]  This, in turn, puts them at higher risk for hyperthermia and the serotonin syndrome.

Another major cause of morbidity and mortality is abnormal fluid balance, electrolyte balance, or both. MDMA stimulates vasopressin release, resulting in SIADH. This, in conjunction with too much water intake during profuse sweating and salt loss (eg, during raves), can lead to severe hyponatremia with subsequent cerebral edema and seizures.


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