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Ecstasy-associated acute severe hyponatremia and cerebral edema: a role for osmotic diuresis?

Abhijeet Ghatol, Amir Kazory

Journal of Emergency Medicine June 2012 DOI: 10.1016/j.jemermed.2009.05.001 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case study Case report Peer reviewed
Sample size 1
Population A young female with MDMA-associated acute severe hyponatremia and cerebral edema
Intervention Mannitol
Topics MDMA
Key findings The authors suggest that osmotic diuresis with mannitol may be considered a possible therapeutic option for MDMA-associated acute symptomatic hyponatremia, based on this case and one previous report. They also note that while inappropriate antidiuretic hormone secretion is a recognized mechanism, other factors such as MDMA-induced polydipsia have been proposed.

Abstract

Ecstasy, or 3,4-methylenedioxymethamphetamine (MDMA), is a drug of abuse with a wide range of toxicity affecting the brain, heart, and liver. Renal toxicity of MDMA is due either to acute kidney injury (e.g., non-traumatic rhabdomyolysis) or to water and electrolyte imbalance (i.e., hyponatremia). Although syndrome of inappropriate secretion of antidiuretic hormone has been recognized as a major mechanism for MDMA-associated hyponatremia, other factors (e.g., MDMA-induced polydipsia) have also been proposed. Hypertonic saline has been used by most authors to treat MDMA-associated acute symptomatic hyponatremia. Our case is the second published report in which mannitol was chosen for management of this pathologic phenomenon. We present a case of MDMA-associated acute severe hyponatremia and cerebral edema in a young female, and analyze the underlying pathophysiology, the therapeutic strategy, and the course of disease. Based on this observation, coupled with the previous report and the complex pathophysiology of this phenomenon, we suggest that osmotic diuresis be considered a possible therapeutic option for MDMA-associated acute symptomatic hyponatremia.

Comparable studies

Other case reports and case series on MDMA, most cited first.

Study Year Design Participants
'Eve' and 'Ecstasy'. A report of five deaths associated with the use of MDEA and MDMA Individuals whose deaths were associated with MDMA or MDEA use 1987 Case series n = 5
Pathology of deaths associated with "ecstasy" and "eve" misuse. Young white men aged 20 to 25 who died after using ring-substituted amphetamines (MDMA... 1996 Case series n = 7
'Eve' and 'Ecstasy' Individuals who died after using MDMA or MDEA 1987 Case series n = 5
A Method of Conducting Therapeutic Sessions with MDMA Clients with clear therapeutic purpose, excluding those with serious functional... 1998 Case study n = 2
Diversity of Psychopathology Associated with use of 3,4-Methylenedioxymethamphetamine (‘Ecstasy’) Psychiatric patients presenting between 1990 and 1992 whose symptoms developed in the... 1994 Case series n = 13

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