Late diagnosis of MDMA-related severe hyponatremia
Case Reports in Internal Medicine – May 27, 2014
Source: OpenAlex
Summary
A 24-year-old woman experienced a severe hyponatremic coma, with serum sodium dropping to a critical 116 mmol/L and significant brain edema. Initial assessments failed to identify MDMA use, as her family denied any illicit drug consumption. It wasn't until six days later that toxicology revealed an alarming MDMA concentration of 7,767 ng/ml in her urine. This case highlights the challenge of diagnosing MDMA-induced hyponatremia without a clear drug history and emphasizes the necessity for prompt toxicological screening in similar situations.
Abstract
Introduction : 3, 4-methylenedioxymethamphetamine (MDMA) is a popular psychoactive amphetamine derivative with the potential to induce life-threatening hyponatremia. The absence of exposure history and typical toxidromes however make the prompt diagnosis of MDMA-induced hyponatremic coma difficult and easily overlooked. Case Report : A 24-year-old female presented to the emergency department with an altered mental status. Physical examinations, laboratory workup and brain imaging study were remarkable for severe hyponatremia (serum sodium 116 mmol/L) and diffuse brain edema only. Her family denied that she had used any illicit drugs. The diagnosis of MDMA-related hyponatremic coma was not made until six days later when toxicologic screen confirmed the presence of high concentration of MDMA (7,767 ng/ml) in the patient’s urine. Conclusion : Our case demonstrates the difficulty in the correct diagnosis of MDMA-induced hyponatremic coma in the absence of MDMA exposure history and typical sympathom imetic effects. A high index of suspicion and prompt toxicological screen are thus important in the diagnosis of MDMA-related severe hypontremia.