Late diagnosis of MDMA-related severe hyponatremia

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 sympathomimetic effects. A high index of suspicion and prompt toxicological screen are thus important in the diagnosis of MDMA-related severe hypontremia.