Ecstasy-Associated Acute Severe Hyponatremia and Cerebral Edema: A Role for Osmotic Diuresis?
- 作者：Abhijeet Ghatol ; MD鈦?/sup> ; Amir Kazory ; MD&dagger ; ;
- 关键词：ecstasy ; hyponatremia ; SIADH ; cerebral edema
- 刊名：Journal of Emergency Medicine
- 出版年：2012
- 期刊代码：156_07364679
- 类别：med
- 出版时间：June, 2012
- 卷：42
- 期：6
- 页码：e137-e140
- 文件大小：157 K
摘要
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.