Abhijeet Ghatol1, Amir Kazory. 1. Department of Medicine, Good Samaritan Hospital, Baltimore, Maryland, USA.
Abstract
BACKGROUND: 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. OBJECTIVES: 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. CASE REPORT: 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. CONCLUSION: 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.
BACKGROUND: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. OBJECTIVES: 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. CASE REPORT: 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. CONCLUSION: 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.
Authors: S Baumann; T Becher; D Frambach; H Wenz; T Kirschning; M Borggrefe; S Rapp; I Akin Journal: Med Klin Intensivmed Notfmed Date: 2015-10-08 Impact factor: 0.840
Authors: Ana C de Bragança; Regina L M Moreau; Thales de Brito; Maria H M Shimizu; Daniele Canale; Denise A de Jesus; Ana M G Silva; Pedro H Gois; Antonio C Seguro; Antonio J Magaldi Journal: PLoS One Date: 2017-07-05 Impact factor: 3.240