Late diagnosis of MDMA-related severe hyponatremia

A 24-year-old woman arrived at the emergency department with altered mental status. Tests showed severe hyponatremia (serum sodium 116 mmol/L) and diffuse brain edema, but no history of drug use was reported. The correct diagnosis of MDMA-induced hyponatremic coma was delayed until six days later, when a toxicology screen revealed a high urine concentration of MDMA (7,767 ng/ml). This case illustrates how the absence of exposure history and typical stimulant effects can make MDMA-related hyponatremic coma easy to overlook. A high index of suspicion and prompt toxicological screening are essential for diagnosing such cases.

Study at a glance

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.