THE CRIPPLING EFFECT OF MOLLY: RAPIDLY PROGRESSIVE MULTIORGAN FAILURE

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Synthetic drugs has been an increasing concern across USA given these drugs are combined with other synthetic drugs not detectable by urine toxicology. Ecstasy is a well known popular drug with street names such as ‘Molly’ which is chemically made up of N-methyl-3,4-methylenedioxy-amphetamine (MDA) or 3,4-methylenedioxy-methamphetamine (MDMA). Here we present a case of Molly overdose resulting in rapid multiple system organ failure. CASE PRESENTATION: 24 year old male with past medical history of Crohn’s Disease on adalimumab presented to ED with altered mental status. He was reportedly to have taken a dose of ‘Molly’ and developed ‘seizure-like’ activities. Vitals showed temperature 106.1F, heart rate 180 beats/minute, respiratory rate 26 breaths/min, BP: 101/52 mmHg, oxygen saturation on room air 98%. Lungs were clear to auscultation except coarse breath sounds at bibasilar bases, tachycardic, diaphoretic, remainder of physical exam was unremarkable. During the ED course, patient became increasingly tachypneic and was intubated and admitted to the MICU for drug overdose. He received aggressive IV fluid hydration with cooling blankets. Within hours of arriving at MICU, patient started to have uncontrollable bleeding from nasal passage, oropharynx, peripheral and central IV access. Coagulation profile was unable to be performed due to extreme high values. Patient was treated for DIC with multiple platelets and FFP transfusions. Lactic acid trended up to 27.9mmol/L. Troponins trended up to 61.3ng/ml. WBC up to 30.6K/uL with AST/ALT increasing up to 1173/1197 U/L and creatinine kinase levels over 50,0000 U/L. Urine toxicology was positive for amphetamines. Poison control recommended to continue with supportive measures and N-Acetylcysteine. Patient was also given cyproheptadine for possible serotonin syndrome. Despite all aggressive measures, patients’ vitals and labs continued to deteriorate and subsequently went into cardiac arrest and expired less than twenty hours after admission. DISCUSSION: There has been increasing concern with recreational drugs being combined with other toxic agents not detected by most urine toxicology screens. Post mortem autopsy on our patient revealed the cause of death as cardiac arrest due to drug intoxication with MDA and MDMA. Some patients can have rapid reversal of multiple organ failure with supportive measures while others as seen with our case can succumb to death in less than twenty-four hours. CONCLUSIONS: This case illustrates the importance of recognizing the multiple organ effects ecstasy can have on an individual. Medical staff should be cognizant of synthetic drug intoxications and consider it as one of their differentials when an individual presents with multiple organ derangements. Protocols should also be implemented at hospitals to address drug overdose especially with the increasing amounts of deaths associated with drug overdose. Reference #1: Hall, A. "Acute toxic effects of ‘Ecstasy’ (MDMA) and related compounds: overview of pathophysiology and clinical management". British Journal of Anaesthesia, vol 96 , no. 6, pp.678 - 685 DISCLOSURES: No relevant relationships by Utpal Bhatt, source=Web Response No relevant relationships by Hung-I Liao, source=Web Response No relevant relationships by Shamanthy Ratnasingam, source=Web Response