Editing MDMA (section)

==Overdose==
MDMA overdose symptoms vary widely due to the involvement of multiple organ systems. Some of the more overt overdose symptoms are listed in the table below. The number of instances of fatal MDMA intoxication is low relative to its usage rates. In most fatalities, MDMA was not the only drug involved. Acute toxicity is mainly caused by [[serotonin syndrome]] and [[sympathomimetic]] effects.<ref name=Steinkellner2011/> Sympathomimetic side effects can be managed with [[carvedilol]].<ref name="RichardsAlbertsonDerlet2015" /><ref name="HysekSchmidRickli2012" /> MDMA's toxicity in overdose may be exacerbated by caffeine, with which it is frequently cut in order to increase volume.<ref>{{cite journal | vauthors = Vanattou-Saïfoudine N, McNamara R, Harkin A | title = Caffeine provokes adverse interactions with 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') and related psychostimulants: mechanisms and mediators | journal = British Journal of Pharmacology | volume = 167 | issue = 5 | pages = 946–59 | date = November 2012 | pmid = 22671762 | pmc = 3492978 | doi = 10.1111/j.1476-5381.2012.02065.x }}</ref> A scheme for management of acute MDMA toxicity has been published focusing on treatment of hyperthermia, hyponatraemia, serotonin syndrome, and multiple organ failure.<ref>{{cite journal | vauthors = Hall AP, Henry JA | title = Acute toxic effects of 'Ecstasy' (MDMA) and related compounds: overview of pathophysiology and clinical management | journal = British Journal of Anaesthesia | volume = 96 | issue = 6 | pages = 678–85 | date = June 2006 | pmid = 16595612 | doi = 10.1093/bja/ael078 | doi-access = free }}</ref>

{| class="wikitable unsortable" style="margin: 1em auto;"
|+ Symptoms of overdose
! scope="col" style="text-align:center"| System
! scope="col" | Minor or moderate overdose<ref name="delaTorreFarréRoset2004" /> || Severe overdose<ref name="delaTorreFarréRoset2004" />
|-
! scope="row"| [[Cardiovascular system|Cardiovascular]]
|
||
* [[Disseminated intravascular coagulation]]<ref name="Acute amph toxicity" />
* [[Intracranial hemorrhage]]<ref name="Acute amph toxicity" />
* Severe [[hypertension]]<ref name="Acute amph toxicity" /><ref name=oxford/> or [[hypotension]]<ref name="Acute amph toxicity" />
* Hypotensive bleeding<ref name=Betzler2017/>
|-
! scope="row"| [[Central nervous system|Central nervous<br />system]]
|
* [[Hyperreflexia]]<ref name="delaTorreFarréRoset2004" />
* [[Psychomotor agitation|Agitation]]<ref name="Acute amph toxicity" /><ref name=oxford/>
* [[Mental confusion]]<ref name="Acute amph toxicity" />
* [[Paranoia]]<ref name="Acute amph toxicity" /><ref name=oxford/>
* [[Stimulant psychosis]]<ref name=Betzler2017/><ref name="pmid22392347" />
|
* [[Cognitive deficit|Cognitive and memory impairment]]<ref name="Acute amph toxicity" /> potentially to the point of [[retrograde amnesia|retrograde]] or [[anterograde amnesia]]<ref>{{cite journal | vauthors = Chummun H, Tilley V, Ibe J | title = 3,4-methylenedioxyamfetamine (ecstasy) use reduces cognition | journal = British Journal of Nursing | volume = 19 | issue = 2 | pages = 94–100 | year = 2010 | pmid = 20235382 }}</ref>
* Coma<ref name="pmid22392347" /><ref name=oxford>{{cite book | vauthors = Kellum JA, Gunn SR, Singer M |title=Oxford American Handbook of Critical Care | date = 2008 |publisher=Oxford University Press |isbn=978-0-19-530528-9 | oclc = 1003197730 | page = 464 }}</ref>
* [[Convulsion]]s<ref name="Acute amph toxicity" /><ref name=oxford/>
* [[Hallucination]]s<ref name="Acute amph toxicity" /><ref name=oxford/>
* [[Loss of consciousness]]<ref name="pmid22392347" />
* [[Serotonin syndrome]]<ref name="pmid22392347" /><ref name="Acute amph toxicity" /><ref name="hyperpyrexia" />
|-
! scope="row"|[[Musculoskeletal system|Musculoskeletal]]
|
|
* [[Hypertonia|Muscle rigidity]]<ref name="Acute amph toxicity" />
* [[Rhabdomyolysis]] (i.e., rapid muscle breakdown)<ref name="Acute amph toxicity" /><ref name="hyperpyrexia" />
|-
! scope="row"| [[Respiratory system|Respiratory]]
|
|
* [[Acute respiratory distress syndrome]]<ref name="Acute amph toxicity" />
|-
! scope="row"| [[Urogenital system|Urinary]]
|
|
* [[Acute kidney injury]]<ref name="Acute amph toxicity" /><ref>{{cite journal | vauthors = Pendergraft WF, Herlitz LC, Thornley-Brown D, Rosner M, Niles JL | title = Nephrotoxic effects of common and emerging drugs of abuse | journal = Clinical Journal of the American Society of Nephrology | volume = 9 | issue = 11 | pages = 1996–2005 | date = November 2014 | pmid = 25035273 | pmc = 4220747 | doi = 10.2215/CJN.00360114 }}</ref>
|-
! scope="row"| Other
|
|
* [[Cerebral edema]]<ref name="pmid22392347" />
* [[Hepatitis]]<ref name="Acute amph toxicity" /><ref name="hyperpyrexia" />
* [[Hyperpyrexia]] (a life-threatening elevation of body temperature greater than or equal to {{convert|40.0|or|41.5|C|F|1}})<ref name="Acute amph toxicity" /><ref name="hyperpyrexia" />
* [[Hyponatremia]] ([[syndrome of inappropriate antidiuretic hormone]])<ref name="Acute amph toxicity">{{cite journal | vauthors = Greene SL, Kerr F, Braitberg G | title = Review article: amphetamines and related drugs of abuse | journal = Emergency Medicine Australasia | volume = 20 | issue = 5 | pages = 391–402 | date = October 2008 | pmid = 18973636 | doi = 10.1111/j.1742-6723.2008.01114.x | s2cid = 20755466 }}</ref><ref name="Hyponatremia">{{cite journal | vauthors = Keane M | title = Recognising and managing acute hyponatraemia | journal = Emergency Nurse | volume = 21 | issue = 9 | pages = 32–6; quiz 37 | date = February 2014 | pmid = 24494770 | doi = 10.7748/en2014.02.21.9.32.e1128 }}</ref><ref name="hyperpyrexia" />
|}