Rebound Hyperthermia After Suicide With MDMA

Wei-Ting Liu ； Tom Chau ； Sung-Sen Yang

《Acta Nephrologica》 34卷4期 (2020/12) Pp. 192-196

https://doi.org/10.6221/AN.202012_34(4).0006

摘要

MDMA (3,4-methylenedioxymethamphetamineage), a widely abused recreational drug, is rarely used for suicide and its associated severe hyperthermia and serotonin syndrome may result in a high mortality rate if cooling managements are not timely. We presented a case of a 20-year-old Chinese male who presented with hyperthermia (41°C) after a suicide attempt with 4 tablets of MDMA. After aggressive cooling managements and treatment with dantrolene, the patient had a 37.9°C body temperature 2 hours after arriving. A rebound hyperthermia to 41.5°C with profound shock occurred despite aggressive treatment and the patient expired 3 days later. Concentrations of MDMA in the initial serum and urine were relatively low. The rebound hyperthermia, in this case, was likely due to MDMA and its active metabolite (MDA, 3,4-methylenedioxyamphetamine), which is determined by the genetic polymorphisms of cytochromes P 450 enzymes. Poor metabolizer may have a greater risk of severe complications after MDMA ingestion. Aggressive cooling and dantrolene therapy should be initiated immediately if severe hyperthermia presents.

關鍵字

hyperthermia ； MDA ； MDMA ； serotonin syndrome ； suicide