Abstract
3,4-methylenedioxymethamphetamine (MDMA), substance known as "Ecstasy" among the people and used due to entertainment, euphoric and energy booster effect, is one of the famous synthetic stimulants. 22-year-old man was found as unconscious in the early morning. According to the expressions of his family and friends, it was learned that he drank alcohol until late in the previous evening and took ecstasy besides this before he died. It was reported that he was taken to intensive care unit with temperature of 41oC and death occurred 12 hours later. At autopsy in external examination, petechial and purpuric hemorrhages in purple and red color were detected on body. In internal examination, petechial hemorrhages on the surface of the heart and lungs, subendocardial hemorrhage in the heart, hemorrhage on the mucosal surface of the stomach were seen. In the toxicological analyses of the blood, Paracetamol (4870 ng/ml), MDMA (847 ng/ml), MDA (94,2 ng/ml), Lidocaine (23 ng/ml), Pantoprazole (10,5 ng/ml), Midazolam (1,83 ng/ml) were detected. The death occurred due to coagulopathy related MDMA intoxication. Here, we present a case of autopsy, clinical findings and histopathologic findings, laboratory results in medicolegal literature.
References
S. Ramcharam, P.L. Meenhorst, J.M.M.B. Otten et al. Survival after massive Ecstasy overdose, Clin. Toxicol. 1998;727-731. DOI: https://doi.org/10.3109/15563659809162623 [PMid:9865243]
Chadwick IS, Curry PD, Linsley A, Freemont AJ, Doran B. Ecstasy, 3-4 methylenedioxymethamphetamine (MDMA), a fatality associated with coagulopathy and hyperthermia. J R Soc Med. 1991;84(6):371. DOI: https://doi.org/10.1177/014107689108400622 [PMid:1676424 PMCid:PMC1293290]
García-Repetto R, Moreno E, Soriano T, Jurado C, Giménez MP, Menéndez M. Tissue concentrations of MDMA and its metabolite MDA in three fatal cases of overdose. Forensic Sci Int. 2003;135(2):110-114. DOI: https://doi.org/10.1016/S0379-0738(03)00179-8
Kalant H. The pharmacology and toxicology of ''ecstasy" (MDMA) and related drugs. CMAJ 2001;165: 917-928.
de la Torre R, Farre M, Roset PN, et al. Human pharmacology of MDMA: pharmacokinetics, metabolism and disposition. Ther Drug Monit 2004; 26: 137-144. DOI: https://doi.org/10.1097/00007691-200404000-00009 [PMid:15228154]
Henry JA, Jeffreys KJ, Dawling S. Toxicity and deaths from 3,4-methylenedioxymethamphetamine ('Ecstasy'). Lancet 1992;340: 384-387. DOI: https://doi.org/10.1016/0140-6736(92)91469-O
Regenthal R, Kruger M, Rudolph K, Trauer H, Preiss R. Survival after massive 'ecstasy' (MDMA) ingestion. Intensive Care Med 1999; 25: 640-641. DOI: https://doi.org/10.1007/s001340050920 [PMid:10416925]
Mallick A, Bodenham AR. MDMA induced hyperthermia: a survivor with an initial body temperature of 42.9 degrees C. J Accid Emerg Med. 1997;14(5):336-338. DOI: https://doi.org/10.1136/emj.14.5.336 [PMid:9315942 PMCid:PMC1343106]
Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter serotonin toxicity criteria:simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635. DOI: https://doi.org/10.1093/qjmed/hcg109 [PMid:12925718]
Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005; 352:1112-1120. DOI: https://doi.org/10.1056/NEJMra041867 [PMid:15784664]
Sano R, Hasuike T, Nakano M, Kominato Y, Itoh H. A fatal case of myocardial damage due to misuse of the "designer drug" MDMA. Leg Med (Tokyo). 2009;11(6):294-297. DOI: https://doi.org/10.1016/j.legalmed.2009.09.003 [PMid:19828353]
Milroy CM, Clark JC, Forrest ARW. Pathology of deaths associated with''ecstasy" and ''eve". J Clin Pathol 1996;49 :149-153. DOI: https://doi.org/10.1136/jcp.49.2.149 [PMid:8655682 PMCid:PMC500349]
Gouzoulis-Mayfrank E, Daumann J (2006) The confounding problem of polydrug use in recreational ecstasy/MDMA users: a brief overview.J Psychopharmacol 20:188-193. DOI: https://doi.org/10.1177/0269881106059939 [PMid:16510477]
Kashem MA, Ahmed S, Sarker R, Ahmed EU, Hargreaves GA,McGregor IS (2012) Long-term daily access to alcohol alters dopamine-related synthesis and signaling proteins in the rat striatum.Neurochem Int 61:1280-1288. DOI: https://doi.org/10.1016/j.neuint.2012.08.013 [PMid:22995788]
Urban NB, Girgis RR, Talbot PS et al. Sustained recreational use of ecstasy is associated with altered pre and postsynaptic markers of serotonin transmission in neocortical areas: a PET study with [(1)(1)C]DASB and [(1)(1)C]MDL 100907.Neuropsychopharmacology 2012;1465-1473. DOI: https://doi.org/10.1038/npp.2011.332 [PMid:22353758 PMCid:PMC3327851]
Spronk DB, Dumont GJ, Verkes RJ, De Bruijn ER. The acute effects of MDMA and ethanol administration on electrophysiological correlates of performance monitoring in healthy volunteers. Psychopharmacology (Berl). 2014;231(14):2877-2888. DOI: https://doi.org/10.1007/s00213-014-3456-y [PMid:24770624]

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