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Doyle AJ, Meyer J, Breen K, Hunt BJ. N-Methyl-3,4-methylendioxymethamphetamine (MDMA)-related coagulopathy and rhabdomyolysis: A case series and literature review. Res Pract Thromb Haemost 2020; 4:829-834. [PMID: 32685891 PMCID: PMC7354411 DOI: 10.1002/rth2.12360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 11/11/2022] Open
Abstract
Coagulation changes, thrombosis, and hemorrhage have been described in patients following N-methyl-3,4-methylenedioxymethylamphetamine (MDMA) intoxication who subsequently developed serotonin syndrome and rhabdomyolysis. The clinical features and mechanism of this remain poorly described. We describe 5 sequential cases admitted to critical care due to severe recreational MDMA toxicity where coagulopathy occurred, and discuss key clinical issues. All patients presented with hyperpyrexia then developed subsequent rhabdomyolysis accompanied by a coagulopathy within 24 hours of presentation. This included a severe thrombocytopenia, prolonged coagulation times, grossly elevated D-dimer levels, and hypofibrogenemia. Multiorgan dysfunction was seen in all patients, including stroke in one patient and major hemorrhage in another. In 2 cases, low-dose low-molecular-weight heparin was used early after presentation, with no significant bleeding complications. Blood products usage was high but variable between the patients with lower use in those who received low-molecular-weight heparin early. Other treatments included intravascular therapeutic cooling, renal replacement therapy with large filter pores and cyprohepatidine. Current evidence suggests that in this group, rhabdomyolysis with subsequent myosin release may be a profound activator of coagulation leading to disseminated intravascular coagulation. Myosin-activated coagulation seems a potential cause of MDMA-related coagulopathy in the setting of rhabdomyolysis and serotonin syndrome. Further studies are needed to validate this and explore the use of low-molecular-weight heparin to reduce the clinical effects of this coagulopathy.
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Affiliation(s)
- Andrew J. Doyle
- Centre for Thrombosis & HaemophiliaSt Thomas' HospitalLondonUK
| | - Joel Meyer
- Department of Intensive Care MedicineSt Thomas' HospitalLondonUK
| | - Karen Breen
- Centre for Thrombosis & HaemophiliaSt Thomas' HospitalLondonUK
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2
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Abstract
CLINICAL ISSUE Illicit drugs can cause a myriad of CNS damages. The toxicity might be caused by the drug itself or by diverse contaminants. The most common changes are ischemic and hemorrhagic stroke as well as subarachnoid hemorrhage and leukoencephalopathies. This article gives a review of the most important morphological imaging findings of the CNS in illicit drug users. PRACTICAL RECOMMENDATIONS In cases of stroke or unclear leukoencephalopathies in young adults, the differential diagnosis of illicit drug use should be considered.
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Affiliation(s)
- A Bachhuber
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland.
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3
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Gökay S, Yildizdaş R, Sari M, çelik T, Horoz Ö, Yilmaz H. A Paediatric Case of Acute Respiratory Distress Syndrome following Toxicity due to Ecstasy. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ecstasy, the street name for 3,4-methylenedioxyamphetamine, is a derivative of amphetamine with sympathomimetic effects and may cause life-threatening sudden cardiac arrhythmias, severe hyponatraemia, seizures and multiple organ failures. A three-year-old male child had been intubated after a seizure due to accidental intake of ecstasy when he presented to our paediatric emergency unit. On physical examination, the patient had poor health status and was unconscious and his pupils were mydriatic, his body temperature was 37.6 degree Celsius, his heart rate was 148/min, his blood pressure was 120/80 mmHg, his PaO2/FiO2 was 72 mmHg and his oxygen index was 18. Toxicological analyses showed 3,4-methylenedioxyamphetamine. The patient was diagnosed as acute respiratory distress syndrome. Appropriate ventilation strategies were used. On the ninth day after his admission, the patient had stabile vital signs and he was discharged. In this report, this three-year-old paediatric case of acute respiratory distress syndrome due to ecstasy intake will be presented. (Hong Kong j.emerg.med. 2016;23:238-241)
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Affiliation(s)
| | - Rd Yildizdaş
- Çukurova University, School of Medicine, Department of Pediatric Intensive Care, Adana, Turkey
| | - My Sari
- Çukurova University, School of Medicine, Department of Pediatric Intensive Care, Adana, Turkey
| | | | - öö Horoz
- Çukurova University, School of Medicine, Department of Pediatric Intensive Care, Adana, Turkey
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4
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Vakde T, Diaz M, Uday K, Duncalf R. Rapidly reversible multiorgan failure after ingestion of "Molly" (pure 3,4-methylenedioxymethamphetamine): a case report. J Med Case Rep 2014; 8:204. [PMID: 24942782 PMCID: PMC4082171 DOI: 10.1186/1752-1947-8-204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction “Molly” is a street name for pure 3,4-methylenedioxymethamphetamine, an amphetamine derivative which acts by enhancing the release of neurotransmitters such as serotonin, dopamine and norepinephrine. This produces euphoria, increased sensory awareness and central stimulation that make it a popular club drug. Nevertheless, it is also associated with serious side effects. We report an unusual case of rapid multiorgan failure after ingestion of “Molly”. Unlike previously described patterns of 3,4-methylenedioxymethamphetamine-related organ failure, our case does not appear to be related to hyperthermia, rhabdomyolysis or hyponatremia. Case presentation A 24-year-old Hispanic man presented to our hospital with an episode of seizure and subsequently developed acute kidney injury, respiratory failure requiring mechanical ventilation and congestive heart failure after ingestion of “Molly”. He rapidly recovered with supportive care and was discharged home. Conclusions The spectrum of complications associated with 3,4-methylenedioxymethamphetamine is wide and patient presentation may vary. Moreover, there appears to be multiple mechanisms involved in organ failure. Drug toxicity should be suspected while evaluating a patient with multisystem organ failure of unclear etiology. Treatment is generally supportive sometimes requiring mechanical ventilation and hemodialysis. Nevertheless, complete reversal of organ failure can be expected.
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Affiliation(s)
- Trupti Vakde
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA.
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5
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Concheiro M, Baumann MH, Scheidweiler KB, Rothman RB, Marrone GF, Huestis MA. Nonlinear pharmacokinetics of (+/-)3,4-methylenedioxymethamphetamine (MDMA) and its pharmacodynamic consequences in the rat. Drug Metab Dispos 2013; 42:119-25. [PMID: 24141857 DOI: 10.1124/dmd.113.053678] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
3,4-Methylenedioxymethamphetamine (MDMA) is a widely abused illicit drug that can cause severe and even fatal adverse effects. However, interest remains for its possible clinical applications in posttraumatic stress disorder and anxiety treatment. Preclinical studies to determine MDMA's safety are needed. We evaluated MDMA's pharmacokinetics and metabolism in male rats receiving 2.5, 5, and 10 mg/kg s.c. MDMA, and the associated pharmacodynamic consequences. Blood was collected via jugular catheter at 0, 0.5, 1, 2, 4, 6, 8, 16, and 24 hours, with simultaneous serotonin (5-HT) behavioral syndrome and core temperature monitoring. Plasma specimens were analyzed for MDMA and the metabolites (±)-3,4-dihydroxymethamphetamine (HHMA), (±)-4-hydroxy-3-methoxymethamphetamine (HMMA), and (±)-3,4-methylenedioxyamphetamine (MDA) by liquid chromatography-tandem mass spectrometry. After 2.5 mg/kg MDMA, mean MDMA Cmax was 164 ± 47.1 ng/ml, HHMA and HMMA were major metabolites, and <20% of MDMA was metabolized to MDA. After 5- and 10-mg/kg doses, MDMA areas under the curve (AUCs) were 3- and 10-fold greater than those after 2.5 mg/kg; HHMA and HMMA AUC values were relatively constant across doses; and MDA AUC values were greater than dose-proportional. Our data provide decisive in vivo evidence that MDMA and MDA display nonlinear accumulation via metabolic autoinhibition in the rat. Importantly, 5-HT syndrome severity correlated with MDMA concentrations (r = 0.8083; P < 0.0001) and core temperature correlated with MDA concentrations (r = 0.7595; P < 0.0001), suggesting that MDMA's behavioral and hyperthermic effects may involve distinct mechanisms. Given key similarities between MDMA pharmacokinetics in rats and humans, data from rats can be useful when provided at clinically relevant doses.
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Affiliation(s)
- Marta Concheiro
- Chemistry and Drug Metabolism Section (M.C., K.B.S., M.A.H.), and Designer Drug Research Unit (M.H.B., R.B.R.), Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland; and Department of Neuroscience, Weill Cornell Medical College, New York, New York (G.F.M.)
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6
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Abstract
PURPOSE OF REVIEW Ingestions and iatrogenic administration of drugs are all too common causes of acute kidney injury. This review will discuss these preventable causes of acute kidney injury. RECENT FINDINGS Recent studies have examined the pathophysiology of acute kidney injury by several commonly used drugs. These studies have shown that drugs and toxins can cause acute kidney injury by altering renal hemodynamics, direct tubular injury or causing renal tubular obstruction. SUMMARY Knowledge of the drugs that cause acute kidney injury and how this injury is manifested can lead to improved diagnosis and treatment with the ultimate goal of prevention.
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Mueller M, Kolbrich-Spargo EA, Peters FT, Huestis MA, Ricaurte GA, Maurer HH. Hydrolysis of 3,4-methylenedioxymethamphetamine (MDMA) metabolite conjugates in human, squirrel monkey, and rat plasma. Anal Bioanal Chem 2009; 393:1607-17. [PMID: 19183967 PMCID: PMC3163102 DOI: 10.1007/s00216-009-2607-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 12/19/2008] [Accepted: 01/08/2009] [Indexed: 01/16/2023]
Abstract
Characterizing the formation of metabolites of 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") in different species (rat, squirrel monkey, and human) may provide insight into mechanisms of MDMA neurotoxicity. Two prominent MDMA metabolites, 3,4-dihydroxymethamphetamine (HHMA) and 4-hydroxy-3-methoxymethamphetamine (HMMA), are conjugated with glucuronic or sulfuric acid, but reference standards are not available; therefore, quantification is only possible after conjugate cleavage. Different concentrations of HHMA and HMMA were obtained in human, squirrel monkey, and rat plasma specimens when acid or enzymatic cleavage was performed. Our data document that these differences are due to species-specific influences on conjugate cleavage. Acidic hydrolysis should be used for analyzing free HHMA and HMMA in human or squirrel monkey plasma, while enzymatic hydrolysis with glucuronidase or sulfatase maximizes recovery of free HHMA and HMMA in rat plasma. Optimization of cleavage conditions showed that sulfate conjugates were more readily cleaved by acid hydrolysis and glucuronides by glucuronidase.
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Affiliation(s)
- Melanie Mueller
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, 66421 Homburg, (Saar), Germany. Department of Neurology, The Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
| | - Erin A. Kolbrich-Spargo
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institute of Health, Baltimore, MD 21224, USA. Criminal Investigation Laboratory, Southwestern Institute of Forensic Sciences, Dallas, TX 75235, USA
| | - Frank T. Peters
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, 66421 Homburg, (Saar), Germany
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institute of Health, Baltimore, MD 21224, USA
| | - George A. Ricaurte
- Department of Neurology, The Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
| | - Hans H. Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, 66421 Homburg, (Saar), Germany
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8
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Mueller M, Peters FT, Ricaurte GA, Maurer HH. Validated liquid chromatographic-electrospray ionization mass spectrometric assay for simultaneous determination of 3,4-methylenedioxymethamphetamine and its metabolites 3,4-methylenedioxyamphetamine, 3,4-dihydroxymethamphetamine, and 4-hydroxy-3-methoxymethamphetamine in squirrel monkey plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 855:262-70. [PMID: 17646137 PMCID: PMC2682589 DOI: 10.1016/j.jchromb.2007.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 06/18/2007] [Accepted: 06/21/2007] [Indexed: 11/16/2022]
Abstract
3,4-Methylenedioxymethamphetamine (MDMA) is a recreational drug with neurotoxic potential. Pharmacokinetic data of MDMA and its metabolites may shed light on the mechanism of MDMA neurotoxicity. An LC-MS assay with electrospray ionization (ESI) is presented for quantifying MDMA and its metabolites 3,4-methylenedioxyamphetamine (MDA), 3,4-dihydroxymethamphetamine (HHMA), and 4-hydroxy-3-methoxymethamphetamine (HMMA) in squirrel monkey plasma. The method involved enzymatic conjugate cleavage and protein precipitation. Separation was achieved within 14min. The method was validated according to international guidelines with respect to selectivity, linearity, accuracy, precision, recovery, and matrix effect. The present method should prove useful for acquiring pharmacokinetic and toxicokinetic data in squirrel monkeys.
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Affiliation(s)
- Melanie Mueller
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, D-66421 Homburg (Saar), Germany
- Department of Neurology, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Frank T. Peters
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, D-66421 Homburg (Saar), Germany
| | - George A. Ricaurte
- Department of Neurology, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Hans H. Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, D-66421 Homburg (Saar), Germany
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9
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Mokhlesi B, Garimella PS, Joffe A, Velho V. Street drug abuse leading to critical illness. Intensive Care Med 2004; 30:1526-36. [PMID: 14999443 DOI: 10.1007/s00134-004-2229-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2003] [Accepted: 10/15/2003] [Indexed: 11/26/2022]
Abstract
Critical care physicians are frequently confronted with intoxicated patients who have used street drugs. In the last decade there has been an upward trend in the use of these substances, particularly amongst adolescents and young adults in large urban areas. In excess quantities all street drugs can lead to critical illness. Early and appropriate medical attention by emergency medicine physicians and intensivists can improve outcomes. In this review article we intend to familiarize critical care physicians with the most common street drugs such as amphetamines, ecstasy, cocaine, gamma hydroxybutyrate, opioids, and phencyclidine.
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Affiliation(s)
- Babak Mokhlesi
- Division of Pulmonary and Critical Care, Cook County Hospital and Rush Medical Center, 1901 West Harrison Street, Suite 2818 B, Chicago, IL 60612, USA.
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10
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Sprague JE, Brutcher RE, Mills EM, Caden D, Rusyniak DE. Attenuation of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy)-induced rhabdomyolysis with alpha1- plus beta3-adrenoreceptor antagonists. Br J Pharmacol 2004; 142:667-70. [PMID: 15159279 PMCID: PMC1575043 DOI: 10.1038/sj.bjp.0705823] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
1. Studies were designed to examine the effects of alpha(1) (alpha(1)AR)- plus beta(3)-adrenoreceptor (beta(3)AR) antagonists on 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy)-induced hyperthermia and measures of rhabdomyolysis (creatine kinase (CK)) and renal function (blood urea nitrogen (BUN) and serum creatinine (sCr)) in male Sprague-Dawley rats. 2. MDMA (40 mg x kg(-1), s.c.) induced a rapid and robust increase in rectal temperature, which was significantly attenuated by pretreatment with the alpha(1)AR antagonist prazosin (100 microg x kg(-1), i.p.) plus the beta(3)AR antagonist SR59230A (5 mg x kg(-1), i.p.). 3. CK levels significantly increased (peaking at 4 h) after MDMA treatment and were blocked by the combination of prazosin plus SR59230A. 4. At 4 h after MDMA treatment, BUN and sCr levels were also significantly increased and could be prevented by this combination of alpha(1)AR- plus beta(3)AR-antagonists. 5. The results from this study suggest that alpha(1)AR and beta(3)AR play a critical role in the etiology of MDMA-mediated hyperthermia and subsequent rhabdomyolysis.
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MESH Headings
- Adrenergic alpha-1 Receptor Antagonists
- Adrenergic beta-3 Receptor Antagonists
- Animals
- Blood Urea Nitrogen
- Body Temperature/drug effects
- Body Temperature/physiology
- Creatine Kinase/antagonists & inhibitors
- Creatine Kinase/blood
- Drug Administration Schedule
- Drug Therapy, Combination
- Fever/chemically induced
- Fever/physiopathology
- Injections, Intraperitoneal
- Injections, Subcutaneous
- Male
- N-Methyl-3,4-methylenedioxyamphetamine/administration & dosage
- N-Methyl-3,4-methylenedioxyamphetamine/adverse effects
- N-Methyl-3,4-methylenedioxyamphetamine/antagonists & inhibitors
- Prazosin/administration & dosage
- Prazosin/blood
- Prazosin/pharmacokinetics
- Propanolamines/administration & dosage
- Propanolamines/blood
- Propanolamines/pharmacokinetics
- Rats
- Rats, Sprague-Dawley
- Receptors, Adrenergic, alpha-1/administration & dosage
- Receptors, Adrenergic, alpha-1/therapeutic use
- Receptors, Adrenergic, beta-3/administration & dosage
- Receptors, Adrenergic, beta-3/therapeutic use
- Rhabdomyolysis/chemically induced
- Rhabdomyolysis/prevention & control
- Time Factors
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Affiliation(s)
- Jon E Sprague
- The Department of Pharmaceutical and Biomedical Sciences, The Raabe College of Pharmacy, Ohio Northern University, Ada, OH 45810, USA.
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11
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Kwon C, Zaritsky A, Dharnidharka VR. Transient proximal tubular renal injury following Ecstasy ingestion. Pediatr Nephrol 2003; 18:820-2. [PMID: 12774221 DOI: 10.1007/s00467-003-1164-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Revised: 02/24/2003] [Accepted: 02/24/2003] [Indexed: 10/27/2022]
Abstract
Multiple renal adverse effects have been anecdotally reported with the ingestion of 3,4-methylenedioxymethamphetamine (Ecstasy), a widely used recreational drug. These side effects include acute renal failure, necrotizing vasculitis, and hyponatremia, the mechanisms for which are unknown. We report a case of transient acute proximal tubular injury and hyponatremia associated with Ecstasy use. An 18-year-old woman presented with new onset seizures and polydipsia. Her initial laboratory evaluation revealed hyponatremia (Na 117 mEq/L), polyuria (urine output >400 mL/h for several hours), renal glycosuria (blood glucose 120 mg/dL, urine glucose >1,000 mg/dL), and solute diuresis (urine osmolality 552 mOsm/kg H2O). Urine electrolyte values reflected a low tubular reabsorption of phosphorus (TRP) of 68.1% (expected TRP >85% at serum P 2.3 mg/dL) with an appropriate transtubular potassium gradient of 3.0 (serum K 3.7 mEq/L). Her hyponatremia was slowly corrected. A repeat TRP after 48 h had normalized to 86.5%, and her glycosuria resolved. An extensive toxin screen was later reported positive for Ecstasy. To our knowledge, this is the first example of an acute and transient proximal tubular injury with Ecstasy ingestion. This complication may become more apparent with increasing use of this drug.
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Affiliation(s)
- Charles Kwon
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
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12
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Sprague JE, Banks ML, Cook VJ, Mills EM. Hypothalamic-pituitary-thyroid axis and sympathetic nervous system involvement in hyperthermia induced by 3,4-methylenedioxymethamphetamine (Ecstasy). J Pharmacol Exp Ther 2003; 305:159-66. [PMID: 12649364 DOI: 10.1124/jpet.102.044982] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An acute and potentially life-threatening complication associated with the recreational use of the 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) is hyperthermia. In the present study, Sprague-Dawley rats treated with MDMA (40 mg/kg s.c.) responded with a significant increase (maximal at 1 h) in rectal and skeletal muscle temperatures that lasted for at least 3 h post-treatment. Hypophysectomized (HYPO) and thyroparathyroidectomized (TX) animals treated with MDMA (40 mg/kg s.c.) did not become hyperthermic and in fact displayed a significant hypothermia. The HYPO and TX animals were also resistant to the serotonergic neurotoxic effects of MDMA assessed by serotonin measurements 4 to 7 days later in the striatum and hippocampus. MDMA (40 mg/kg s.c.) induced a significant increase in thyroxine levels 1 h post-treatment. Thyroid hormone replacement in TX animals returned the hyperthermic response seen after MDMA. Prazosin, an alpha(1)-antagonist (0.2 mg/kg i.p.), administered 30 min before MDMA significantly attenuated the MDMA-induced increase in rectal temperature, but had no effect on skeletal muscle temperature. Cyanopindolol, a beta(3)-antagonist (4 mg/kg s.c.), administered 30 min before MDMA (40 mg/kg s.c.) significantly attenuated the increase in skeletal muscle temperature, but had no effect on the rise in rectal temperature. The combination of prazosin and cyanopindolol resulted in an abolishment of MDMA-induced hyperthermia. The mechanisms of thermogenesis induced by MDMA seem to result from an interaction between the hypothalamic-pituitary-thyroid axis and the sympathetic nervous system, wherein mechanisms leading to core and skeletal muscle hyperthermia after MDMA exposure seem to be differentially regulated by alpha(1)- and beta(3)-adrenergic receptors.
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Affiliation(s)
- Jon E Sprague
- The Department of Pharmaceutical and Biomedical Sciences, The Raabe College of Pharmacy, Ohio Northern University, Ada, Ohio 45810, USA.
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