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Q J Med 2002; 95: 475-483
© 2002 Association of Physicians

Masterclasses in medicine

Acute hyponatraemia and ‘ecstasy’: insights from a quantitative and integrative analysis

D.Z.I. Cherney1, M.R. Davids2 and M.L. Halperin1,

1 From the Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Canada, and 2 Nephrology Unit and Department of Internal Medicine, Stellenbosch University, Cape Town, South Africa

Summary

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.

Notes

Address correspondence to Professor M.L. Halperin, Professor Medicine, University of Toronto, St Michael's Hospital Annex, Lab #1, Research Wing, 38 Shuter Street, Toronto, Ontario M5B 1A6, Canada. e-mail: mitchell.halperin{at}utoronto.ca


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