Which clinical history findings are characteristic of 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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The patient, friends, emergency medical services (EMS), or the authorities may provide history regarding the possibility of drug abuse. These patients usually present on weekends, often late at night or in the early morning hours after many hours of dancing at raves. Emergency Medical Services (EMS) or the authorities can provide information as to the setting in which they were found (eg, clubs, raves, bars).

Sometimes, patients may be carrying MDMA tablets with motif symbols and rave paraphernalia such as neon glow sticks and "smart drinks," which are blended fruit juices with amino acids. However, in the absence of any history, always consider sympathomimetic drugs, such as amphetamines and cocaine, in any young patient who presents with altered mental status and autonomic hyperactivity.

Typically, patients present to the emergency department (ED) either immediately after an ingestion, indicating an acute adverse reaction, or, more commonly, after the euphoric high has subsided and they have tried repeated dosing or co-ingestion with other drugs. Often, patients have mixed toxidromic presentations because of co-ingestion with alcohol, marijuana, ketamine, gamma-hydroxybutyrate (GHB), heroin, or cocaine.

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