Ecstasy hyperthermia caused

Together with GFIB and ecstasy, amphetamines are often referred to as "club drugs," because they are increasingly popular in the club scene. They are often produced in small clandestine laboratories, which makes their precise chemical identification difficult. They differ from ecstasy chiefly in the context of use intravenous administration and "hard core" addiction is far more common with amphetamines, especially methamphetamine. In general, amphetamines lead to elevated catecholamine levels that increase arousal and reduce sleep, whereas the effects on the dopamine system mediate euphoria but may also cause abnormal movements and precipitate psychotic episodes. Effects on serotonin transmission may play a role in the hallucinogenic and anorexigenic functions as well as in the hyperthermia often caused by amphetamines. 

Associated with increased physical activity and altered thermoregulation, ecstasy has been reported to cause unconsciousness, seizures, hyperthermia, tachycardia, hypotension, disseminated intravascular coagulation, and acute renal insufficiency, as well as death. 

The authors observed that three of the six patients had been exposed to ecstasy outside of a rave and had hyperthermia despite not having vigorous muscle activity, thereby questioning previous assumptions about pathogenesis. There were no contaminants in the tablets, based on laboratory analyses. The authors speculated that another cause of hyperthermia and acute toxicity could be a genetic predisposition to defective metabolism of ecstasy, especially CYP2D6 deficiency. They postulated that hyperthermia in ecstasy users could be heterogeneous and was more likely to be due to a combination of causes. 

Rhabdomyolysis may result from prolonged pressure on muscles, from agents that cause muscle spasm or convulsions (phencyclidine, theophylline) or be aggravated by hyperthermia due to muscle contraction, e.g. with MDMA ( ecstasy ). Aggressive volume repletion and correction of acid-base abnormality may be needed, and urine alkalinisation may prevent acute tubular necrosis. 

As recreational use of ecstasy has dramatically increased in recent years, deaths related to its use have been reported. In a retrospective review of all violent deaths from 1992 to 1997 in South Australia, six deaths were associated with ecstasy abuse aU occurred after September 1995. Three victims had documented hyperthermia and there was evidence of hyperthermia in another. The authors suggested that individual susceptibility to MDMA may be caused by impaired metabolism by CYP2D6 or through genetically poor metabolism (seen in 5-9% of Caucasians). One woman, who died with a cerebral hemorrhage, had fluoxetine (a CYP2D6 inhibitor) present in her blood. Furthermore, toxicology identified paramethoxyamfetamine (PMA) in all the cases, amfetamine/metamfetamine in four cases, and... 

Many users sweat, and some talk incessantly. Ecstasy has strong effects on the cardiovascular system and on the body s ability to maintain a normal temperature. Taking Ecstasy at raves is often combined with long periods of vigorous dancing. This can cause the body to become much warmer than normal, which can lead to a condition called hyperthermia. The heart and kidneys... 

There are severe physical risks with using 4-MTA. It is particularly risky to use 4-MTA with other drugs, such as Ecstasy and cocaine. Whether used alone or in combination with other drugs, 4-MTA has been known to cause dangerous cases of hyperthermia that can lead to organ failure and even death. In fact, at least 15 deaths... 

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