BOF: 3.55
A 26-year-old male is brought into accident and emergency
by his friends. He has had a seizure whilst at a nightclub. On direct
questioning his friends admit that the patient had used ecstasy in addition to
drinking several units of alcohol.
On examination he is disorientated and drowsy.
In this patient which one of the following may occur?
a)
Hyponatraemia
b)
Hypokalaemia
c)
Metabolic acidosis
d)
Metabolic alkalosis
e)
Hyperglycaemia
Answer: a)
3,4 methylenedioxymethamphetamine (MDMA), also known as
ecstasy, is an amphetamine derivative
Its action is similar to the stimulant methamphetamine
and the hallucinogen mescaline.
It causes catecholamine release from presynaptic vesicles
It is also is a selective serotonergic neurotoxin that
causes massive release of serotonin and is thought to inhibit its uptake.
Hyponatraemia
Hyponatraemia may occur after MDMA
use. It is caused by a combination of:
ü
Increased water intake
ü
Excessive sweating due to physical exertion
ü
Vasopressin release leading to the syndrome of inappropriate
antidiuretic hormone secretion (SIADH)
In severe hyponatraemia, patients
can develop cerebral oedema with consequent seizures and coma
