Williams H, Dratcu L, Taylor R, Roberts M, Oyefeso A
UMDS, St Thomas' Hospital, London.
J Accid Emerg Med. 1998 Sep;15(5):322-6. doi: 10.1136/emj.15.5.322.
To report on the extent and nature of acute MDMA (ecstasy) related problems presenting to a large London hospital's accident and emergency (A&E) department.
The computerised attendance records for all patients attending the A&E department over a 15 month period were retrospectively screened. Potential cases thus identified had their case notes systematically reviewed to confirm the history of MDMA use and to extract other relevant data.
Forty eight consecutive MDMA related cases were identified. All were in the 15-30 year age group with the majority presenting in the early hours at weekends and having consumed the drug at a night club. The mean number of tablets consumed was two and almost 40% had taken MDMA before. Polydrug use was common with half of the sample having concurrently taken another illicit substance--most commonly other stimulants (amphetamines and cocaine). A wide range of adverse clinical features was found. The most common symptoms were vague and non-specific such as feeling strange or unwell, however many patients had collapsed or lost consciousness. The most common signs elicited were related to sympathetic overactivity, agitation/disturbed behaviour, and increased temperature. The more serious complications of delirium, seizures, and profound unconsciousness (coma) were commoner when MDMA was used in combination with other substances.
For young adults presenting late at night at weekends and exhibiting symptoms of sympathetic overactivity, disturbed behaviour, and increased temperature ("Saturday night fever") the use of stimulant dance drugs especially MDMA should be suspected. As MDMA use does not appear to occur in isolation, the clinical picture is likely to be complicated by multiple rather than single drug ingestion. This poses increased diagnostic and management challenges for A&E staff who typically represent the front line response to dance drug related problems.
报告大量伦敦医院急诊科出现的与摇头丸（迷幻药）相关急性问题的程度和性质。
对15个月期间所有到急诊科就诊患者的电脑出勤记录进行回顾性筛查。如此确定的潜在病例对其病历进行系统回顾，以确认摇头丸使用史并提取其他相关数据。
确定了48例连续的与摇头丸相关病例。所有病例均在15 - 30岁年龄组，大多数在周末凌晨就诊，且在夜总会服用了该药物。平均服用片数为两片，近40%的患者以前服用过摇头丸。多药联用很常见，一半的样本同时服用了另一种非法物质——最常见的是其他兴奋剂（苯丙胺和可卡因）。发现了广泛的不良临床特征。最常见的症状模糊且非特异性，如感觉奇怪或不适，然而许多患者出现了虚脱或失去意识。最常见的体征与交感神经过度活跃、激动/行为紊乱以及体温升高有关。当摇头丸与其他物质联用时，谵妄、癫痫发作和深度昏迷（昏迷）等更严重的并发症更为常见。
对于周末深夜就诊且表现出交感神经过度活跃、行为紊乱和体温升高（“周六夜热”）症状的年轻人，应怀疑使用了刺激性摇头丸类药物，尤其是摇头丸。由于摇头丸的使用似乎并非孤立发生，临床症状可能因多种药物而非单一药物摄入而变得复杂。这给通常作为摇头丸相关问题一线应对人员的急诊科工作人员带来了更大的诊断和管理挑战。
