Abstract
Editor—In their recent review Hall and Hendry1Hall AP Hendry JA Acute toxic effects of ‘Ecstasy’ (MDMA) and related compounds: overview of pathophysiology and clinical management.Br J Anaesth. 2006; 96: 678-685Abstract Full Text Full Text PDF PubMed Scopus (224) Google Scholar advocate the use of dantrolene in the management of hyperthermia in acute MDMA (3,4-methylene-dioxy-meth-amphetamine, ‘Ecstasy’) toxicity. MDMA and other amphetamine analogues may present with the syndrome identical to exercise induced heatstroke, a multisystem disorder which has been reviewed by Bouchama and Knochel.2Bouchama A Knochel JP Heat stroke.N Eng J Med. 2002; 346: 1978-1988Crossref PubMed Scopus (1391) Google Scholar One of these authors also carried out a randomized controlled trial of the use of dantrolene (2 mg kg−1) in heat stroke and found no difference between the treatment and placebo group in terms of cooling time, complications, or length of stay.3Bouchama A Cefege A Devol EB Labdi O El-Assil K Seraj M Ineffectiveness of dantrolene sodium in the treatment of heat stroke.Crit Care Med. 1991; 19: 176-180Crossref PubMed Scopus (117) Google Scholar A recent meta analysis concluded that there is no place for the use of dantrolene in heat stroke.4Smith JE Cooling methods used in the treatment of exertional heat illness.Br J Sports Med. 2005; 39: 503-507Crossref PubMed Scopus (142) Google Scholar In addition, each 20 mg vial of dantrolene contains 3 g of mannitol and is reconstituted in solution of pH 9.5 which alkalinizes the urine, thereby reducing the clearance of amphetamine like drugs such as MDMA. We would recommend that heatstroke of whatever aetiology is treated as a multisystem disorder resembling severe sepsis with appropriate invasive monitoring and organ support including cooling, but not dantrolene. The danger of insidious late development of organ impairment or failure sometime after admission must not be overlooked and will not be prevented by early administration of dantrolene.
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