High incidence of mild hyponatraemia in females using ecstasy at a rave party.
Geetruida D Van Dijken, Renske E. Blom, Ronald J Hené, Walther H Boer
Nephrology, Dialysis, Transplantation September 2013 DOI: 10.1093/ndt/gft023 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cross-sectional study Peer reviewed |
|---|---|
| Sample size | 107 |
| Population | Attendees of an indoor rave party ('Awakenings', Amsterdam, fall 2010): 63 subjects using MDMA and 44 controls |
| Topics | MDMA |
| Keywords | Hyponatriaemia |
| Key findings | Plasma sodium was significantly lower in MDMA users than non-users (138 ± 2 vs 140 ± 2 mmol/L), and hyponatraemia occurred in 14.3% of users overall but 26.7% of women, with the lowest sodium 133 mmol/L. The authors argue that women using MDMA at raves are probably also at risk of severe symptomatic hyponatraemia and propose prevention strategies, including matching electrolyte intake to losses. |
Abstract
Globally, millions of subjects regularly use ecstasy, a drug popular due to its empathogenic and entactogenic effects. Dilutional hyponatraemia, mainly caused by direct stimulation of antidiuretic hormone (ADH) secretion by ecstasy, is among the many side effects of the drug (active substance 3, 4-methylenedioxymethamphetamine, MDMA). Severe, symptomatic hyponatraemia related to the use of MDMA has been reported in more than 30 cases. The mortality of this complication is high and mainly females are involved. Dramatic cases that reach the literature probably represent the tip of the iceberg. We decided to study the incidence of hyponatraemia in subjects using MDMA at an indoor rave party. The study was performed at the indoor event 'Awakenings', held in Amsterdam in the fall of 2010. The plasma sodium concentration was measured at the party using a point of care method in 63 subjects using MDMA and 44 controls. The use of MDMA was confirmed by a urine test. The plasma sodium concentration in subjects using MDMA was significantly lower than in those not using the drug (138 ± 2 mmol/L versus 140 ± 2 mmol/L, respectively, P < 0.001). The overall incidence of hyponatraemia, defined as a plasma sodium concentration <136 mmol/L, was 14.3% in MDMA users (9/63 subjects). Most cases of hyponatraemia occurred in females, in whom the incidence was 26.7% (8 of 30 females), with lowest values of 133 mmol/L. The number of ecstasy pills ingested by the females developing hyponatraemia was not different from that ingested by those who did not develop this complication. Fluid intake in ecstasy users exceeded that of non-users, suggesting a dipsogenic effect of the drug. Only 3% of males, but no less than ∼25% of females attending a rave party and using MDMA developed mild hyponatraemia during the event. Especially females are therefore probably also at risk of developing severe symptomatic hyponatraemia. Not using MDMA is obviously the best option to prevent MDMA-induced hyponatraemia. However, accepting the fact that millions use the drug every weekend, strategies should also be developed to prevent hyponatraemia in subjects choosing to take MDMA. This would include matching the electrolyte content of the fluids and food ingested to that of the fluids that are lost during the use of MDMA, mainly by perspiration. Users of MDMA and emergency health care workers should become more aware of the relatively high incidence of MDMA-induced hyponatraemia and of potential strategies to prevent this complication.
Comparable studies
Other cross-sectional and survey studies on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Recreational MDMA use in Sydney: a profile of ‘Ecstasy’ users and their experiences with the drug Recreational Ecstasy users recruited via snowball peer network | 1992 | Cross-sectional survey | n = 100 |
| Reducedin vivobinding to the serotonin transporter in the cerebral cortex of MDMA (‘ecstasy’) users Male regular ecstasy users and well-matched controls | 1999 | Cross-sectional association study | n = 20 |
| Patterns of simultaneous polysubstance use in drug using university students Drug-using university students | 2006 | Cross-sectional survey | n = 149 |
| Patterns of recreational drug use at dance events in Edinburgh, Scotland Drug users at dance events in Edinburgh, Scotland, UK, aged 16-47, 80% between 18 and... | 2001 | Cross-sectional survey | n = 122 |
| Acute, sub‐acute and long‐term subjective consequences of ‘ecstasy’ (MDMA) consumption in 430 regular users Regular MDMA users | 2003 | Cross-sectional study | n = 466 |
Citations in the library
Cited by 22
- MDMA enhances emotional empathy and prosocial behavior Social Cognitive and Affective Neuroscience October 4, 2013
- Designer drugs: mechanism of action and adverse effects Archives of Toxicology April 1, 2020
- Human psychobiology of MDMA or ‘Ecstasy’: an overview of 25 years of empirical research Human Psychopharmacology: Clinical and Experimental July 1, 2013
- Molecular and clinical aspects of potential neurotoxicity induced by new psychoactive stimulants and psychedelics Experimental Neurology June 4, 2021
- Deaths related to MDMA (ecstasy/molly): Prevalence, root causes, and harm reduction interventions Journal of Substance Use February 20, 2018
and 17 more in the library
Cites 10
- Gender differences in the subjective effects of MDMA Psychopharmacology March 5, 2001
- Plasma Pharmacokinetics of 3,4-Methylenedioxymethamphetamine After Controlled Oral Administration to Young Adults Therapeutic Drug Monitoring May 21, 2008
- Sex Differences in the Effects of MDMA (Ecstasy) on Plasma Copeptin in Healthy Subjects The Journal of Clinical Endocrinology & Metabolism June 30, 2011
- Dance Clubbing on MDMA and during Abstinence from Ecstasy/MDMA: Prospective Neuroendocrine and Psychobiological Changes Neuropsychobiology 2008
- The effect of 3,4‐methylenedioxymethamphetamine (MDMA, ?ecstasy?) and its metabolites on neurohypophysial hormone release from the isolated rat hypothalamus British Journal of Pharmacology February 1, 2002
and 5 more in the library