title: Acute hyponatraemia and 'ecstasy': insights from a quantitative and integrative analysis.
abstract: A 20-year-old woman attended a 'rave party' where she took the drug 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy'). She had used this drug previously without serious adverse effects. On this occasion, while both she and her friends drank a large quantity of water, only she became seriously ill. The initial manifestation was an altered sensorium; several hours later she had a grand mal seizure. In the Emergency Department, the most striking features were the severe degree of hyponatraemia (112 mmol/l) and cerebral oedema. To explain the basis for this life-threatening clinical presentation, an imaginary consultation was sought with Professor McCance. Using both a deductive and a quantitative analysis that involved several medical subspecialties, he illustrated that a simple story of water ingestion and vasopressin release was not sufficient to explain her hyponatraemia. It was only after events in her gastrointestinal tract were analysed that a plausible hypothesis could be constructed.
authors.affiliation: Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Canada. mitchell.halparin@utoronto.ca
authors.forename: D Z I
authors.initials: DZ
authors.lastname: Cherney
authors.forename: M R
authors.initials: MR
authors.lastname: Davids
authors.forename: M L
authors.initials: ML
authors.lastname: Halperin
mesh_terms: D000328:Adult; D004068:Digestive System Physiological Phenomena; D004326:Drinking; D005260:Female; D006213:Hallucinogens / Q000009:adverse effects*; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced* / Q000175:diagnosis; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D012737:Sex Factors; D012964:Sodium / Q000378:metabolism; D013542:Sweat / Q000737:chemistry
chemical_list: D006213:Hallucinogens; D012964:Sodium; D018817:N-Methyl-3,4-methylenedioxyamphetamine