Hyperkalemia in fatal MDMA (‘ecstasy’) toxicity

Raviña, Paula; Quiroga, Jose; Raviña, Tomás

doi:10.1016/s0167-5273(03)00162-1

Cited by 18 publications

(11 citation statements)

References 9 publications

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“…Other amphetamines, including methamphetamine and amphetamine, also cause rhabdomyolysis in human users (Kendrick et al, 1977;Richards et al, 1999). Consistent with ATP depletion, muscle rigor and hyperkalemia are also reported as part of the panoply of symptoms mediated by MDMA toxicity (Dar and McBrien, 1996;Ravina et al, 2004). In our experiments, we measured total creatine kinase activ- ity and did not differentiate the various isoforms.…”

Section: Discussionmentioning

confidence: 85%

“…Along with hyperthermia, persons with MDMA-induced toxicity can develop rhabdomyolysis, muscle rigidity (Dar and McBrien, 1996), renal failure (Fahal et al, 1992), and hyperkalemia (Ravina et al, 2004). Despite its popularity and prevalent usage, we have only recently begun to understand the thermogenic mechanisms of MDMA and how they contribute to human toxicities.…”

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confidence: 99%

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The Role of Mitochondrial Uncoupling in 3,4-Methylenedioxymethamphetamine-Mediated Skeletal Muscle Hyperthermia and Rhabdomyolysis

Rusyniak¹,

Tandy²,

Hekmatyar³

et al. 2005

J Pharmacol Exp Ther

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Use of the popular club drug ecstasy (3,4-methylenedioxymethamphetamine, MDMA) can result in life-threatening hyperthermia and rhabdomyolysis. Recent studies show a link between skeletal muscle uncoupling proteins in MDMA-mediated hyperthermia. The mechanisms by which MDMA interacts with skeletal muscle mitochondria are largely unknown. The present study was designed to comprehensively evaluate the effects of MDMA on bioenergetics and toxicity of skeletal muscle. Using 31 P nuclear magnetic resonance (NMR) and serum creatine kinase levels, we demonstrate evidence for uncoupling of oxidative phosphorylation in the skeletal muscle of MDMA (40 mg/kg)-treated rats. In vivo, rats treated with MDMA had significantly elevated serum creatine kinase levels, a marker of rhabdomyolysis, 4 h post-MDMA treatment (955 Ϯ 132 IU/l) compared with saline-treated controls (373.2 Ϯ 59 IU/l). ␤-ATP signal areas after MDMA treatment showed significant reductions (15%) from the baseline values with corresponding increases in inorganic phosphate (88% increases) and decreases in intracellular pH. Clark electrode experiments on isolated skeletal muscle mitochondria in vitro (1-5 mM MDMA) and ex vivo in MDMA-treated animals demonstrated no evidence of uncoupling of oxidative phosphorylation. In vitro experiments using L6 myotubules cocultured with primary hepatocytes demonstrated the presence of uncoupling protein-3 in the L6 myotubules, but no evidence of a direct effect of MDMA or its potential metabolites on cellular creatine kinase concentrations. These findings suggest that MDMA uncouples skeletal muscle mitochondria in vivo but that this uncoupling is the result of indirect mechanisms.

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Section: Discussionmentioning

confidence: 85%

mentioning

confidence: 99%

The Role of Mitochondrial Uncoupling in 3,4-Methylenedioxymethamphetamine-Mediated Skeletal Muscle Hyperthermia and Rhabdomyolysis

Rusyniak¹,

Tandy²,

Hekmatyar³

et al. 2005

J Pharmacol Exp Ther

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“…(9). We found only one case of Ecstasy intoxication with hyperkalemia as the immediate cause of death after pure MDMA intoxication (10). One other patient was recently treated with dialysis but died 4 days later of multiple organ failure (11).…”

Section: Discussionmentioning

confidence: 96%

Rhabdomyolysis in MDMA Intoxication: A Rapid and Underestimated Killer. “Clean” Ecstasy, a Safe Party Drug?

Eede

Montenij

Touw

et al. 2012

The Journal of Emergency Medicine

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“…Hyperkalemia in the absence of renal failure may result from MDMA intake and result in cardiotoxicity. 18 In the 3 reported cases of an acute myocardial necrosis, there were no underlying identifiable cardiac risk factors (family history, diabetes, obesities, vascular disease, etc) other than the amphetamine abuse that could explain the development of necrotic or ischemic pathology. There also was no coronary pathology or myocardial bridging of the coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

Fatal Amphetamine-Associated Cardiotoxicity and Its Medicolegal Implications

Jacobs

2006

The American Journal of Forensic Medicine and Pathology

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Amphetamines are popular drugs of abuse, particularly among youngsters and at dance scenes. Cardiotoxicity (manifested as cardiomyopathy, acute myocardial infarction/necrosis, heart failure, or arrhythmia) after the recreational (mis)use of amphetamine and its synthetic derivatives has been documented but is rather rare. Amphetamine-related cardiac fatalities are even more rare. We present 6 cases of young persons who died unexpected after the chronic abuse of amphetamines. Death was not attributed to a lethal intoxication but to an acute myocardial necrosis, a right ventricle rupture, a cardiomyopathy, or an arrhythmia. Two of the deceased persons presented prior to their death to the emergency department, but their complaints were not considered (probably due to their young age) to be of cardiac origin. One case was a sport-related fatality where medical screening failed to identify the underlying cardiac pathology or the amphetamine abuse, and 1 case was a so-called idiopathic dilated cardiomyopathy where substance abuse was not considered by the treating physician. We think that amphetamine-associated cardiotoxicity is a rare but probably genuine entity that should be considered both in forensic and clinical/emergency medicine because of its potential medicolegal implications.

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Hyperkalemia in fatal MDMA (‘ecstasy’) toxicity

Cited by 18 publications

References 9 publications

The Role of Mitochondrial Uncoupling in 3,4-Methylenedioxymethamphetamine-Mediated Skeletal Muscle Hyperthermia and Rhabdomyolysis

The Role of Mitochondrial Uncoupling in 3,4-Methylenedioxymethamphetamine-Mediated Skeletal Muscle Hyperthermia and Rhabdomyolysis

Rhabdomyolysis in MDMA Intoxication: A Rapid and Underestimated Killer. “Clean” Ecstasy, a Safe Party Drug?

Fatal Amphetamine-Associated Cardiotoxicity and Its Medicolegal Implications

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