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Barrett PJ. 
“'Ecstasy' misuse--overdose or normal dose?”. 
Anaesthesia. 1993;48(1):83.
Abstract
I read with interest the recent case report regarding ecstasy overdose and its subsequent treatment with dantrolene (Anaesthesia 1992: 47: 686-7). Although the patient undoubtedly suffered a severe adverse reaction to the drug, a 'massive overdose' cannot be assumed because the 'normal' dose varies between drug users, the purity of this illicitly manufactured drug is impossible to quantify and there was no estimation of plasma 3.4-methylenedioxy- metamphetamine (MDMA) levels to prove the degree of toxicity. In addition, a severe metabolic acidosis was tolerated. Whilst acidosis will encourage the renal excretion of drugs like 'ecstasy' it will also encourage the renal deposition of myoglobin and increase the risks of renal failure. Hyperkalaemia and seizure activity from which the patient suffered would also be less responsive to therapy, and sodium biocarbonate is indicated in such cases.
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