Ecstasy (MDMA) Seychelles

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Ecstasy (MDMA) Seychelles

Methylenedioxymethamphetamine (MDMA) Toxicity (Ecstasy Toxicity)

Ecstasy (MDMA) Seychelles

Seychelles' drug problem threatens the success of its blue economy

Ecstasy (MDMA) Seychelles

It differs pharmacologically in that it has both stimulatory and mild psychedelic properties, noted to be equivalent to that of hallucinogenic mescaline, however, auditory and visual hallucinations are uncommon. MDMA elicits its neurochemical effects in much the same manner as amphetamines and methamphetamines, by stimulating catecholamine release of norepinephrine and dopamine, and blocking presynaptic reuptake of these catecholamines. Additionally, the mescaline-like ring structure enhances both serotonergic and dopaminergic release, as well as inhibition of serotonin reuptake. MDMA was classified as a Schedule I drug by the Drug Enforcement Administration DEA in , as it had been linked to neurotoxicity and potential brain damage, and therefore data from clinical studies have been very limited. It is noted to give users a sense of euphoria, empathy, and decreased inhibitions, lasting approximately 3—6 hours. It is also taken in conjunction with marijuana and alcohol. Unfortunately, for clinicians attempting to identify the agent ingested, what is being sold in the street as pure MDMA, often times had been adulterated with a wide variety of chemical and pharmaceutical substitutes: acetaminophen, ibuprofen, methamphetamine, caffeine, dextromethorphan, ephedrine, and cocaine are common. The typical amount of MDMA varies from 30— mg, or none at all. The data is then published online along with pill image and name, active contents, its sales location, and the date tested. As the drugs purity is typically in question, the clinician must always consider other variants being sold as pure MDMA. One drug which has come to the attention of researchers and clinicians is paramethoxyamphetamine PMA , which has been associated with a higher incidence of death than MDMA at relatively lower doses. In addition to stimulating the release of serotonin, it also acts as a monoamine oxidase inhibitor MAOI , which can result in serotonin syndrome and can lead to refractory hyperthermia and death. On occasion, it is pooled with data on stimulants, and in others, with hallucinogenics, although it lacks true hallucinogenic properties. The report showed a significant increase in lifetime use among individuals aged 12 years or older, from 4. Among persons aged 12—49 years, the average age at first use of MDMA was Among young adults aged 18—25 years, males were more likely to have used ecstasy during the past year than females. However, among youths aged 12—17 years, females were more likely to have used ecstasy during the past year than males. As with any ingestion, whenever possible, obtaining a detailed history is of the upmost importance. Type of drug, amount taken, last ingestion time, frequency of use, route, and coingestants can guide therapeutic interventions. It is important to remember that MDMA is manufactured clandestinely and therefore the true composition and purity are difficult to establish. However, it is not recommended to delay care while identifying the offending agent or agents. Drug toxicology can be erroneous and delaying care while awaiting the results can have negative implications on patient outcomes. The user can present with a wide variety of signs and symptoms from CNS stimulation following use, with most being mild and non-life threatening. During the acute phase minor reactions have been reported including: anxiety, nausea, euphoria, enhanced sensory perception, pupillary dilation, diaphoresis, bruxism, dry mouth, tachycardia, and hypertension. The development of serious side effects of MDMA intoxication vary individually and there is no established correlation between the amount of MDMA taken and severity of side effects. Case reports have confirmed that some individuals have died after consuming only one dose of MDMA, while others have consumed relatively lethal doses and have survived. A list is provided of the potential life-threatening complications which have been observed with MDMA toxicity and it should be kept in mind by the clinician assessing the patient:. Laboratory and radiological testing depends on the severity of the intoxicated patient and should be expanded based on the history and physical. A complete metabolic panel along with a creatine phosphokinase CPK is indicated in all patients. Additional testing should be tailored to each patient. Complete metabolic panel: to monitor for hyponatremia, hyperkalemia, acute renal failure, acute liver failure and metabolic acidosis. Urine drug testing for MDMA can be erroneous and therefore supportive care should not be delayed while awaiting the results. However, it may support the clinical diagnosis and also provide information on common drugs of abuse which may have been taken concurrently. Acutely intoxicated patients are at risk for developing a wide range of medical complications from minor symptoms, which require minimal intervention, to potentially life-threatening side effects, which require intubation, sedation, and monitoring within an intensive care unit ICU setting. Following the acronym ABC Airway, Breathing, Circulation , along with establishing good intravenous access, is essential. Clinical intervention is managed on an individual basis and is typically supportive in nature. Hyponatremia associated with MDMA use can be multi-factorial. Many users are aware of the risks of developing hyperthermia, and compensate by drinking copious amounts of water leading to delusional hyponatremia. This can be exacerbated in individuals already taking selective serotonin reuptake inhibitor SSRI or other psychotropic medications. Serious neurological complications resulting from hyponatremia include altered mental status, seizures, cerebral edema, and death. MDMA has structural similarity to serotonin, which accounts for increased serotonin release and inhibition of serotonin reuptake. Severe symptoms of serotonin syndrome consist of the triad of cognitive-behavioral, neuromuscular and autonomic derangements. This results in hyperthermia, agitation, seizures, hyperflexia and altered mental status, leading to refractory hyperthermia, multisystem organ failure, and death. In most cases hyperthermia is associated with excessive activity without adequate fluid replacement. Additional factors can be from dancing for long hours without breaks in poorly ventilated areas. Clinicians should always consider serotonin syndrome as a possible cause. Sudden cardiac death has been postulated to occur secondary to sympathomimetic stimulation, resulting in lethal dysrhythmias. Individuals with undiagnosed cardiac disease and conduction abnormalities are at greater risk. Patients with evidence of end-organ damage, focal neurological deficits, arrhythmias, delirium, or uncontrolled agitation should be admitted for observation. Substance abuse referrals should also be made prior to discharge. Nitroprusside: 0. A beta blocker may be used only if an alpha adrenergic antagonist is concomitantly administered. Use of a beta blocker without alpha blockade may result in paradoxical increase in BP as it may cause unopposed alpha-receptor stimulation. Diazepam: 5—10 mg IV push initially, may repeat every 5—10 minutes as needed; consider a second agent if seizures persist or recur after total dose of 30 mg diazepam administered. For severe cases intubation and sedation with a non-depolarizing neuromuscular blocker is indicated. Frequent monitoring of serum sodium levels, to eliminate rapid correction leading to osmotic demyelination syndrome. Cyproheptadine a 5-HT2 antagonist : 4—12 mg PO; limited research, but has shown to be effective in case reports. SMA Findings, All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Show More. Login Register. We want you to take advantage of everything Cancer Therapy Advisor has to offer. To view unlimited content, log in or register for free. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Jump to Section I. Diagnostic Approach. What is the differential diagnosis for this problem? Historical information important in the diagnosis of this problem. Physical Examination maneuvers that are likely to be useful in diagnosing the cause of this problem. Laboratory, radiographic and other tests that are likely to be useful in diagnosing the cause of this problem. Management while the Diagnostic Process is Proceeding. What's the Evidence? Please login or register first to view this content. Open Next post in Hospital Medicine Close. Allergic bronchopulmonary aspergillosis. Want to view more content from Cancer Therapy Advisor?

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