MDMA overdose symptoms vary widely due to the involvement of multiple organ systems. Some of the more overt overdose symptoms are listed in the table below. The number of instances of fatal MDMA intoxication is low relative to its usage rates. In most fatalities MDMA was not the only drug involved. Acute toxicity is mainly caused by serotonin syndrome and sympathomimetic effects.  MDMA's toxicity in overdose may be exacerbated by caffeine, with which it is frequently cut (mixed with to increase volume).  A scheme for management of acute MDMA toxicity has been published focusing on treatment of hyperthermia, hyponatraemia, seratonin syndrome, and multiple organ failure. 
The Institute of Medicine generally recommends a Daily Dietary Allowance of vitamin D at 600 IU/day with the Upper Level Intake at 4,000 IU/day for bone health (50) , but food sources are limited. Oral supplementation has been shown to be the safest way to increase vitamin D levels (51) , although considerable debate continues on how this may translate in optimizing vitamin D status (45) . Therefore, patients should consult with their physicians if a deficiency is suspected to assess whether more vitamin D is needed for health maintenance and to avoid side effects such as kidney stones or high levels of calcium in blood or urine.