Multiple MDMA (Ecstasy) Overdoses at a Rave Event

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  • Patil Armenian
    California Poison Control System–San Francisco Division, San Francisco, CA, USA
  • Tanya M. Mamantov
    California Poison Control System–San Francisco Division, San Francisco, CA, USA
  • Ben T. Tsutaoka
    California Poison Control System–San Francisco Division, San Francisco, CA, USA
  • Roy R. L. Gerona
    Department of Laboratory Medicine, San Francisco General Hospital, University of California–San Francisco, San Francisco, CA, USA
  • Eric F. Silman
    Department of Emergency Medicine, University of California–San Francisco, San Francisco, CA, USA
  • Alan H. B. Wu
    Department of Laboratory Medicine, San Francisco General Hospital, University of California–San Francisco, San Francisco, CA, USA
  • Kent R. Olson
    California Poison Control System–San Francisco Division, San Francisco, CA, USA

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  • A Case Series

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<jats:p> Twelve patients with 3,4-methylenedioxymethamphetamine (MDMA) toxicity from a single rave event presented to multiple San Francisco Bay area hospitals with various life-threatening complications including seizures and hyperthermia. Eight required emergent endotracheal intubation and six had hypotension. Hyperkalemia, acute kidney injury, and rhabdomyolysis were present in most of the patients. In all, 2 patients died, 4 survived with permanent neurologic, musculoskeletal, and/or renal sequelae, and 6 survived without any apparent lasting deficits. Hyperthermia was present in 10 patients and was severe (40.9-43° C) in 7. Using multiple cooling methods, the average time to achieve cooling was 2.7 hours. Serum drug analysis was performed on 3 patients, demonstrating toxic MDMA concentrations without the presence of other xenobiotics. Two capsules confiscated by police at the event contained 82% and 98% MDMA, respectively, without other pharmacologically active compounds. Capsule #2 contained 270 mg MDMA, which is more than twice the amount of MDMA usually contained in 1 dose. The MDMA-induced hyperthermia significantly contributed to the morbidity and mortality in this case series. Factors contributing to the severity of the hyperthermia include ingestion of large doses of MDMA, a warm ambient environment, and physical exertion. </jats:p>

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