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BJA Advance Access published online on April 4, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael078
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review Article

Acute toxic effects of ‘Ecstasy’ (MDMA) and related compounds: overview of pathophysiology and clinical management

A. P. Hall 1 * and J. A. Henry 2

1 Department of Anaesthesia and Intensive Care Medicine, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK
2 Academic Department of Accident and Emergency Medicine, Imperial College London, 1st Floor QEQM Wing, St Mary's Campus, Norfolk Place, Paddington, London W2 1PG, UK

* To whom correspondence should be addressed.
A. P. Hall, E-mail: andrew.p.hall{at}uhl-tr.nhs.uk


  Abstract

Since the late 1980s ‘Ecstasy’ (3,4-methylenedioxymethamphetamine, MDMA) has become established as a popular recreational drug in western Europe. The UK National Criminal Intelligence Service estimates that 0.5-2 million tablets are consumed weekly in Britain. It has been reported that 4.5% of young adults (15-34 yr) in the UK have used MDMA in the previous 12 months. Clinically important toxic effects have been reported, including fatalities. While the phenomenon of hyperpyrexia and multi-organ failure is now relatively well known, other serious effects have become apparent more recently. Patients with acute MDMA toxicity may present to doctors working in Anaesthesia, Intensive Care and Emergency Medicine. A broad knowledge of these pathologies and their treatment is necessary for anyone working in an acute medical speciality. An overview of MDMA pharmacology and acute toxicity will be given followed by a plan for clinical management.

Keywords: complications, convulsions; complications, death; complications, hepatotoxicity; complications, hyperthermia; complications, hyponatraemia; toxicity, 3,4-methylenedioxymethamphetamine, MDMA (Ecstasy).
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E-letters:

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'Ecstasy' (MDMA) and malignant hyperthermia
Mark U. Gerbershagen, et al.
British Journal of Anaesthesia, 15 Nov 2006 [Full text]
'Ecstasy' and MH
Andrew P Hall, et al.
British Journal of Anaesthesia, 27 Nov 2006 [Full text]

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