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A bolt out of the blue: the night of the blue pills

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Clinical record

A cluster of 10 patients presented during the night of 31 December 2013 to the emergency department of Royal Perth Hospital with states of agitated delirium or exhibiting unusual behaviour. Eight of the patients had attended an open-air dance party in the city close to the hospital, and nine had arrived by ambulance. All except one admitted to taking non-prescription drugs in tablet form, most believing they were consuming ecstasy (3,4-methylenedioxymethamphetamine, MDMA) in the form of blue or grey pills, in several cases imprinted with a lightning bolt. Media warnings had already been issued in response to similar cases involving acute psychosis reported by another metropolitan emergency department (Fremantle Hospital).1,2

The median age of the patients in our cluster was 20 years (interquartile range [IQR], 18–22 years). The median initial heart rate was 115 beats per minute (IQR, 84–155 beats per minute). Four patients were febrile (temperature ≥ 37°C) but only one had a temperature greater than 38°C. All patients had dilated pupils (median width, 6 mm [IQR, 5–7 mm]). Five patients required intravenous sedation, and in two cases more than 50 mg diazepam was required.

The patients had posed a significant risk to themselves before attending the emergency….