HDCN Article Review/Hyperlink

Holden R, Jackson MA

Near fatal hyponatremic coma due to vasopressin over- secretion after "ecstasy" (3,4-MDMA)

Lancet (Apr) 347:1052 1996

Holden and Jackson report a young woman who developed severe hyponatremia after ingestion of the illicit drug "ecstasy." 3,4-methylenedioxymetamphetamine was present in her urine. Despite a serum sodium measurement of 112 mmol/L, her urine sodium was also 112 mmol/L and her urine osmolality was 256 mosm/kg. Plasma arginine vasopressin was 4.5 pmol/L, indicating vasopressin excess in the presence of hyponatremia.

Comment: Patients ingesting illicit drugs frequently present to the Emergency Room with altered mental status. Although eliminating trauma as a cause is an important and immediate consideration, the metabolic effects of the drugs frequently result in acute psychosis, delirium, stupor, or coma. This case is the first report of amphetamine stimulation of vasopressin release. As such, it emphasizes the need for urgent electrolyte measurements and attention to fluid balance in persons presenting with illicit drug ingestion. (George R. Aronoff, M.D., University of Louisville, Kentucky)