ACUTE LIVER-DAMAGE AND ECSTASY INGESTION

Eight cases of ecstasy related acute liver damage referred to a specia lised liver unit are described. Two patients presented after collapse within six hours of ecstasy ingestion with hyperthermia, hypotension, fitting, and subsequently disseminated intravascular coagulation with rhabdomyolysis together with biochemical evidence of severe hepatic da mage. One patient recovered and the other with evidence of hyperacute liver failure was transplanted but subsequently died, histological exa mination showing widespread microvesicular fatty change. Four patients presented with acute liver failure without hyperthermia. All four ful filled criteria for transplantation, one patient survived after transp lantation, one died before a donor organ became available, and two die d within one month posttransplantation of overwhelming sepsis. Histolo gical examination showed submassive lobular collapse. Two patients pre sented with abdominal pain and jaundice and recovered over a period of three weeks; histological examination showed a lobular hepatitis with cholestasis. Patients developing jaundice or with evidence of hepatic failure particularly encephalopathy and prolongation of the internati onal normalised ratio, or both, whether or not preceded by hyperthermi a, should be referred to a specialised liver unit as liver transplanta tion probably provides the only chance of recovery.