A 22-year-old man who ingested MDMA developed serotonin syndrome, leading to an electrical storm and refractory cardiac arrest. Extracorporeal life support, combined with vasoactive drugs, renal replacement therapy, and mechanical ventilation, successfully managed his hemodynamic instability. His temperature was rapidly regulated, and all hemodynamic support was weaned within the first week of hospitalization. Extracorporeal life support offers advantages in treating hemodynamic instability caused by serotonin syndrome.
A 32-year-old woman with MELAS syndrome died suddenly 1–12 hours after a single ketamine infusion for depression and PTSD. Autopsy showed methemoglobin at 71% of hemoglobin, far above the normal 0–2% range. The authors speculate that ketamine may have triggered fatal methemoglobinemia by reducing ATP production and impairing methemoglobin reductase, a mitochondrial toxic effect. They conclude that ketamine should be used cautiously in MELAS patients, especially those with a seizure history, and that such patients require careful monitoring during and after infusion.