Concerning Ecstasy (MDMA)...

A 19-yr -old woman is referred to the Medical Admissions Unit by her GP. A few hours before she had taken some ecstasy (MDMA) while out clubbing.

Which of the following is true concerning ecstasy (MDMA)?
A. It produces stimulation of the parasympathetic nervous system
B. Hyponatraemia can be due to SIADHS
C. Dantrolene is contraindicated in the management of hyperthermia
D. Most deaths are due to associated hyponatraemia
E. Effects only last for 2-3 hours

Answer:
B--Hyponatraemia can be due to SIADHS

Discussion: Ecstasy is an amphetamine derivative (methylenedioxymethamfetamine, MDMA) and its
effect is to cause stimulation of the sympathetic nervous system. The effects of ecstasy usually
occur within 1 hour and typically last for 4–6 hours, although in large ingestions they can last for up to 48 hours.
Unwanted effects include

• cardiac arrhythmias (the principal cause of MDMA-associated deaths), 
• hyponatraemia, 
• hypertension and 
• hyperthermia. 

Hyponatraemia can occur either because of an excessive fluid intake or because of SIADHS (syndrome of inappropriate antidiuretic hormone secretion).

Treatment of hyperthermia includes giving cold IV fluids if the core temperature is over 39°C: if this is ineffective, it should be followed by iv dantrolene and/or paralysis and ventilation