Hyponatremia Associated with MDMA (Ecstasy) Intoxication

Risk factors for hyponatremia:

(1) excessive sweating (from dancing, hyperthermia, etc) with water replacement

(2) excessive water intake from compulsive or uninhibited behavior

(3) intentionally drinking a large amount of fluids to avoid dehydration or toxicity

(4) syndrome of inappropriate ADH secretion (SIADH)

(5) dry mouth and throat

(6) excessive thirst (often associated to one or more of the above mechanisms)

Clinical findings may include:

(1) confusion

(2) convulsions

(3) delirium

(4) coma

Laboratory findings:

(1) moderate to severe hyponatremia

(2) elevation of serum arginine vasopressin (AVP) with SIADH

(3) diuresis with dilute urine, or oliguria with hypertonic urine (with SIADH)

Additional concerns:

(1) nephropathy secondary to MDMA, including rhabdomyolysis

(2) serotonin syndrome and hyperthermia