Anest. intenziv. Med. 2025;36(1):29-33 | DOI: 10.36290/aim.2024.065

Fatal ecstasy (MDMA) intoxication with extreme hyperpyrexia, rhabdomyolysis, and disseminated intravascular coagulopathyCase Report

Mynář M.¹, Samek J.^{1, 2}, Břízová P.², Zátopková L.³, Hejna P.³, Turek Z.^{1, 2}

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové

² Kardiochirurgická klinika, Univerzita Karlova, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové

³ Ústav soudního lékařství, Univerzita Karlova, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové, Hradec Králové

Ecstasy (MDMA - 3,4-methylenedioxymethamphetamine) is a synthetic psychoactive amphetamine with stimulatory effects on the user's sympathetic nervous system. The prevalence of MDMA misuse has been widely increasing in young people below 20 years of age. For first-time users, MDMA is considered the most dangerous drug in terms of serious complications such as extreme hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulopathy, and brain edema. The presented case study describes fatal MDMA intoxication in young men with rapid onset of extreme hyperpyrexia above 42 °C, massive rhabdomyolysis, DIC, and multiple organ failure leading to death. Diagnostics and organ support strategies are described, and the possible role of early dantrolene administration and hemadsorption filter use during renal replacement therapy are discussed in detail. There are no specific treatment algorithms for MDMA intoxication, therapy is mainly symptomatic and focussed on the radical decrease of core temperature altogether with deep sedation, renal replacement therapy, and support of hemostasis. The initial core temperature is the most important prognostic factor for survival related to the degree of rhabdomyolysis and DIC or brain edema development.

Keywords: MDMA intoxication, hyperpyrexia, rhabdomyolysis, DIC, dantrolen.

Received: December 2, 2024; Revised: December 18, 2024; Accepted: December 19, 2024; Prepublished online: January 8, 2025; Published: April 28, 2025  Show citation