A case study on MDMA. Two fatal cases involving young adults

The introduction of new stimulants seems not to hamper the still widespread consumption of MDMA (3,4-methylenedioxymethamphetamine) among young people, especially in determined nightlife settings. Herein, we present two different MDMA-related deaths, providing pathological, histopathological and toxicological data integration. A hypothesis for the mechanisms of the deaths is also discussed. Case 1: an insulin-dependent 16-year-old girl died in a discotheque after the ingestion of MDMA. Before dying she presented seizure, bruxism, trismus, sweating and reduced consciousness. Biochemistry showed hyperglycaemia and hyponatraemia. Toxicological analyses revealed blood MDMA concentration of 1750 ng/mL. Autopsy, accompanied by histological examination, identified cerebral oedema due to hypotonic hyponatraemia as cause of death. Case 2: a 16-year-old girl collapsed during dancing at a rave party. She died 15 hours later in hospital. Autopsy and histology revealed epicardial haemorrhage, hepatitis and disseminated intravascular coagulation. Toxicological analyses revealed blood MDMA concentration of 3700 ng/ml. Cause of death was identified as fulminant liver failure. Since death is not strictly correlated with MDMA blood concentration, to better understand the aetiology of the death after MDMA consumption an integrated and multidisciplinary approach is strongly recommended.