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Hyponatremia - written by babydoc_vic

LiquidMafia

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Hyponatraemia: Written by babydoc_vic

ECSTASY AND HYPONATRAEMIA / WATER INTOXICATION

The purpose of this FAQ is to educate MDMA users on the risk of dilutional hyponatraemia (DH) related to MDMA use. DH was found to be a major contribution to the cause of death in some highly publicised e-related deaths, including Leah Betts in the UK(1), Anna Woods in Australia(2) and Brittney Chambers in the USA(3). The Coroner that ruled in each of these cases found MDMA the cause of death, as use of MDMA led to DH. DH related to MDMA is considered relatively rare, but in fact it should never, ever happen as it is completely preventable.

DEFINITION
Dilutional hyponatraemia (also called water intoxication) occurs when an individual ingests excessive amounts of water, leading to a drop in blood sodium levels. This can lead to water entering brain cells under osmotic pressure(1). This makes the brain swell inside the skull (cerebral oedema) (4), which puts pressure on the brain stem. This can cause brain damage, seizures(4), paralysis, respiratory arrest, coma(4) and death.

WHY DOES DH OCCUR IN MDMA USERS?
NOTE: I refer to MDMA only, however it is likely that similar effects could occur with MDA or MDEA use. Of great importance is the fact that DH occurs with unadulterated MDMA - it is not the result of binders, contaminants or other drugs like PMA or DXM.

Say we have a person who takes MDMA - let's call him Bob. When Bob uses MDMA, he likes to dance. He then feels hot and drinks a lot of water to try to counteract this. Also, Bob may be aware of the potential risk of dehydration related to using MDMA and dancing, so he drinks lots of water to try to protect against dehydration. Bob fills up his bottle with water in the bathroom, to avoid buying the expensive drinks at the bar.
There are two contributing factors leading to DH in MDMA users. Firstly, when you dance you lose sodium (salt) via sweating. If not replaced, this may lead to a drop in blood sodium levels. Drinking a lot of plain water (that is more than 3 litres) in an attempt to re-hydrate yourself will lead to blood sodium levels dropping even further(4).

The second factor is this: MDMA use appears to lead to release of a hormone known as anti-diuretic hormone (ADH). This hormone basically tells the kidneys to retain fluid. When this happens inappropriately, it is known as Syndrome of Inappropriate Anti-Diuretic Hormone secretion (SIADH). This is why people often have trouble urinating when they use e. It is unclear whether SIADH is a direct effect of MDMA, or a result of the body responding to hypovolaemia (decreased blood volume due to heavy sweating and/or diarrhoea) by increasing ADH release (5) or a combination(4).

So, you have Bob dancing, sweating, drinking lots of water and not being able to pee, or maybe peeing just a little. Eventually, Bob starts to feel sick: he might have a headache, nausea or vomiting to start with. This may progress to diarrhoea, hypersalivation (lots of saliva), muscle tremors or twitches, mental confusion, seizures and urinary frequency or incontinence(6). Vomitting and diarrhoea will increase the electrolyte imbalance even more. At this point, cerebral oedema is starting to occur and Bob needs to go to hospital.

Luckily, Bob's friends are smart enough to realise something is seriously wrong, and call an ambulance. They tell the ambulance officers what Bob took, what he has been doing and how long he has been sick. This makes it a lot easier for the hospital staff to work out what is wrong with Bob and get him the right treatment quickly. Thanks to their quick action, Bob makes a full recovery (yeah!).

HOW TO PREVENT MDMA RELATED DH
If you use MDMA and are dancing, try to limit your fluid intake to 500ml per hour (2 cups of fluid) (2). Sip your drink, don't gulp it down. Also, minimise your intake of plain water where possible. Isotonic sports drinks are ideal as they help to maintain normal electrolyte balance. Alternatively, add 1-2 teaspoons of salt to each litre (which is just under 2 pints) of fluid you drink(1). Take a few salt sachets with you, and add these to water or juice. If you drink too much isotonic fluids, you may get swelling in your body tissues, but not in your brain as your blood sodium levels will remain normal(1). If you are not dancing, then 250mls (one cup) of fluid per hour is sufficient to protect against dehydration(2). Also, take breaks from dancing, and go somewhere cool to help your body cool down and reduce the need to sweat. Even if you don't feel like peeing, keep trying.

Of note, in the case of both Anna Woods and Brittney Chambers, both were reportedly seeking large amounts of water prior to becoming unconcious - whether they thought this would rid them of the negative effects they were feeling, or is a direct result of DH is unclear. But if you notice a friend becoming unwell and drinking large amounts of water, try to stop them. If possible, offer them ice blocks instead, as this will help to cool them without ingesting large amounts of water. Or pour the water over them, to aid cooling.

While it may be normal for some people to vomit once (or twice at most) when MDMA is coming on, repeated vomiting is not normal. Repeated vomiting will cause further fluctuations in blood electrolyte levels, and may be a sign of DH. So keep a close eye on anyone who takes MDMA and vomits repeatedly.

If someone you know appears to have symptoms of DH, they need prompt medical attention. The most common symptoms appear to be vomitting, confusion and seizures or seizure like movements. Don't be frightened of getting into trouble. If medical help is summoned early enough, then DH can be treated. Be sure to tell the ambulance staff what the person has had, as this will make it easier for them to do their job. The consequences of untreated DH are extremely serious: brain damage and death.

By babydoc_vic, Dec 2001

REFERENCES
1. Leah Betts died of drinking water to counter drug’s effect http://www.urban75.com/Drugs/drugxtc1.html
2. Coroner’s report. Reasons for dispensing with inquest. Death of Anna Victoria Wood. http://www.erowid.org/chemicals/mdma/mdma_health5.shtml
3. Ecstasy Triggered Death -edit: Dead Link
4. Yew, D; Hahn, H. Toxicity, MDMA.. http://www.emedicine.com/emerg/topic927.htm
5. Zenenberg, R; Goldfarb, D. Evaluation of hyponatremia associated with use of Methylenedioxymethamphetamine (MDMA). Int J Med Toxicology 2000; 3(5): 30 http://www.ijmt.net/3_5/3_5_30.html
6. Water Issues with MDMA use: Dehydration, Overhydration & Heat stroke by Erowid http://www.erowid.org/chemicals/mdma/mdma_health_water.shtml
ALSO WORTH A LOOK - PERSONAL REPORTS OF DH
Dancesafe http://www.dancesafe.org/ubb/ultimatebb.php?ubb=get_topic&f=20&t=000028
Bluelight http://www.bluelight.ru/ubb/ultimatebb.php?ubb=get_topic&f=15&t=003527 <- Dead Link
[ 04 March 2002: Message edited by: johnboy ]
[edited dead link]
[ 08 February 2003: Message edited by: forgotten ]
 
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