3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) is associated with liver injury which can be fatal.
The cause of the hepatotoxicity may be the MDMA or a chemical in the synthetic batch.
Hepatotoxicity includes:
(1) acute toxic hepatitis
(2) fulminant hepatic necrosis
(3) chronic hepatitis
An acute presentation may include:
(1) rhabdomyolysis
(2) hyperthermia
(3) DIC
(4) hypotension
(5) seizures
(6) abdominal pain
(7) acute renal failure
(8) hyponatremia
(9) hypoglycemia
(10) lethargy
Signs of liver injury:
(1) hepatic encephalopathy
(2) jaundice
(3) elevated liver function tests
(4) high INR
(5) ascites
The diagnosis requires:
(1) history of ecstasy exposure prior to the onset of the hepatitis
(2) resolution upon discontinuation of drug abuse
(3) exclusion of other causes of hepatitis including cocaine abuse.
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Specialty: Gastroenterology, Toxicology
