Polydipsia as another mechanism of hyponatremia after ???ecstasy??? (3,4 methyldioxymethamphetamine) ingestion

Brvar, Miran; Koželj, Gordana; Osredkar, Joško; Možina, Martin; Gricar, Marko; Bunc, Matjaž

doi:10.1097/00063110-200410000-00014

Cited by 34 publications

(31 citation statements)

References 13 publications

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“…In the past, Ecstasy users have been advised via "word of mouth" and the alternative media to drink copious amounts of water and/or non-alcoholic "energy tonics" to prevent dehydration and hyperthermia (1,5,21). However, excessive hydration can contribute to hyponatremia (25) and has been reported in cases of Ecstasy-associated hyponatremia (4). Rave parties and dance clubs typically involve high ambient temperatures and sustained dancing and physical exertion which may lead to excessive sweating, electrolyte loss and dehydration, all factors in the development of hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Ecstasy-Associated Hyponatremia in California

Rosenson

Smollin

Sporer

et al. 2007

Annals of Emergency Medicine

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Study objective: To describe the clinical characteristics of patients with Ecstasy (MDMA)-associated hyponatremia (serum sodium less than 130 mmol/L) reported to the California Poison Control System (CPCS) over a five-year period and to determine if a gender difference exists among patients with Ecstasy-associated hyponatremia. Methods:We performed a retrospective review of cases involving Ecstasy intoxication reported to the CPCS and recorded in its computerized database from January 1, 2000 through October 9, 2005 We excluded all "information only" calls, cases managed at home, cases with no gender specified and cases in which the outcome was coded as "no effect", "unrelated -probably not responsible", "confirmed non-exposure", "judged as non-toxic-expect no effect", and "minimal clinical effects possible". Confirmation of exposure to MDMA was based on the history of use and, when available, urine toxicology screen testing positive for MDMA or amphetamine derivatives. Hyponatremia was defined as a measured serum sodium less than 130 mmol/L.Results: A total of 1,436 cases involving Ecstasy were reported to the CPCS over the 5-year study period, of which 891 were excluded based on the criteria described above. Of the 545 cases that met inclusion criteria, 296 (54.3%) were females and 249 (45.7%) were males. There were 188 cases (34.5%) with a documented serum sodium, including 73/188 (38.8%) with hyponatremia (Na < 130 mmol/L). Of the 73 subjects with hyponatremia, there were 55 (75.3%) females and 18 (24.7%) males; of the 115 non-hyponatremic subjects 50 (43.5%) were female and 65 (56.5%) male. There was no observed gender difference in the ascertainment of serum sodium levels. Among patients with a documented serum sodium level, female gender was 3 associated with increased odds of hyponatremia by univariate analysis (OR 3.97; 95% CI 2.08 -7.59). Conclusion:Female gender was associated with increased odds of hyponatremia among persons with Ecstasy intoxication and a documented serum sodium level reported to CPCS from 2000 -2005. Multiple potential study confounders, including spectrum bias, incomplete laboratory data and individual differences in subject characteristics prevent determination of causality regarding gender differences in the incidence of Ecstasy-associated hyponatremia and its complications.

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Section: Discussionmentioning

confidence: 99%

Patterns of Ecstasy-Associated Hyponatremia in California

Rosenson

Smollin

Sporer

et al. 2007

Annals of Emergency Medicine

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“…This is due, in part, to an inadvertently harmful response to the hyperpyrexia seen with ecstasy use: The institution of "chill out" areas at clubs and raves (66). These areas feature free or reduced-priced water or low-solute-content drinks (e.g., sports beverages), which can be obtained with the goal of hydrating to prevent hyperpyrexia and volume depletion.…”

Section: Hyponatremia and Ecstasymentioning

confidence: 99%

“…The ready availability of fluids is compounded by the effects of amphetamines to induce dry mouth and the sensation of thirst. Whether ecstasy leads to a primary drive to drink secondary to its CNS effects is not known but has been hypothesized (66,67). In one dramatic case, an 18-yr-old woman pre- …”

Section: Hyponatremia and Ecstasymentioning

confidence: 99%

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The Agony of Ecstasy

Campbell

Rosner

2008

Clinical Journal of the American Society of Nephrology

108

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Ecstasy (MDMA, 3,4-methylenedioxymethamphetamine) is commonly used by college-aged individuals. Ecstasy leads to feelings of euphoria, emotional empathy, and increased energy. These effects come at a significant risk for complications. Ecstasy has been associated with acute kidney injury that is most commonly secondary to nontraumatic rhabdomyolysis but also has been reported in the setting of drug-induced liver failure and drug-induced vasculitis. More common, ecstasy has led to serious hyponatremia and hyponatremia-associated deaths. Hyponatremia in these cases is due to a "perfect storm" of ecstasy-induced effects on water balance. Ecstasy leads to secretion of arginine vasopressin as well as polydipsia as a result of its effects on the serotonergic nervous pathways. Compounding these effects are the ready availability of fluids and the recommendation to drink copiously at rave parties where ecstasy is used. The effects of ecstasy on the kidney as well as therapeutic measures for the treatment of ecstasy-induced hyponatremia are presented.

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“…Ingestion of ecstasy (3,4 methyldioxymethamphetamine or MDMA) has also been associated with severe acute hyponatremia. 26 The underlying pathophysiology is thought to result from a large intake of free water coupled with SIADH.…”

Section: Hypervolemic Hypo-osmolar Hyponatremiamentioning

confidence: 99%

Les troubles de l’équilibre hydrosodé chez les patients hospitalisés

Bagshaw

Townsend

McDermid

2008

Can J Anesth/J Can Anesth

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Purpose To review and discuss the epidemiology, contributing factors, and approach to clinical management of disorders of sodium and water balance in hospitalized patients. Source An electronic search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and a search of the bibliographies of all relevant studies and review articles for recent reports on hyponatremia and hypernatremia with a focus on critically ill patients. Principal findings Disorders of sodium and water balance are exceedingly common in hospitalized patients, particularly those with critical illness and are often iatrogenic. These disorders are broadly categorized as hypo-osmolar or hyper-osmolar, depending on the balance (i.e., excess or deficit) of total body water relative to total body sodium content and are classically recognized as either hyponatremia or hypernatremia. These disorders may represent a surrogate for increased neurohormonal activation, organ dysfunction, worsening severity of illness, or progression of underlying chronic disease. Hyponatremic disorders may be caused by appropriately elevated (volume depletion) or inappropriately elevated (SIADH) arginine vasopressin levels, appropriately suppressed arginine vasopressin levels (kidney dysfunction), or alterations in plasma osmolality (drugs or body cavity irrigation with hypotonic solutions). Hypernatremia is most commonly due to unreplaced hypotonic water depletion (impaired mental status and/or access to free water), but it may also be caused by transient water shift into cells (from convulsive seizures) and iatrogenic sodium loading (from salt intake or administration of hypertonic solutions). Conclusion In hospitalized patients, hyponatremia and hypernatremia are often iatrogenic and may contribute to serious morbidity and increased risk of death. These disorders require timely recognition and can often be reversed with appropriate intervention and treatment of underlying predisposing factors.

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Polydipsia as another mechanism of hyponatremia after ???ecstasy??? (3,4 methyldioxymethamphetamine) ingestion

Cited by 34 publications

References 13 publications

Patterns of Ecstasy-Associated Hyponatremia in California

Patterns of Ecstasy-Associated Hyponatremia in California

The Agony of Ecstasy

Les troubles de l’équilibre hydrosodé chez les patients hospitalisés

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