Traub Stephen J, Hoffman Robert S, Nelson Lewis S
New York City Poison Control Center, New York, New York 10014, USA.
J Urban Health. 2002 Dec;79(4):549-55. doi: 10.1093/jurban/79.4.549.
3,4-Methylenedioxymethamphetamine (MDMA, or "ecstasy") has gained an undeserved reputation as a "safe" drug among its users. However, hyperthermia, rhabdomyolysis, hepatotoxicity, disseminated intravascular coagulation, long-term serotonergic neurotoxicity, and death are all associated with MDMA use. Hyponatremia is also reported, and its manifestations are frequently delayed several hours after the drug is ingested. The etiology of this hyponatremia is unclear; both the syndrome of inappropriate antidiuretic hormone release (SIADH) and free-water intoxication are advanced as explanations. We describe a 19-year-old female who presented to the emergency department with altered mental status 1 day after using MDMA. Her initial serum sodium was 121 mmol/L, and computerized tomography (CT) of her head demonstrated cerebral edema. She was treated with hypertonic saline and fluid restriction, and her serum sodium increased to 132 mmol/L over the next 24 hours. She regained consciousness completely within 48 hours of presentation and recovered uneventfully. MDMA toxicity, particularly the pathophysiology and treatment of MDMA-induced hyponatremia, are discussed.
3,4-亚甲基二氧甲基苯丙胺（摇头丸，或“迷魂药”）在其使用者中获得了一种名不副实的“安全”药物声誉。然而，高热、横纹肌溶解、肝毒性、弥散性血管内凝血、长期5-羟色胺能神经毒性及死亡均与使用摇头丸有关。低钠血症也有报道，其表现常在摄入药物数小时后出现延迟。这种低钠血症的病因尚不清楚；抗利尿激素分泌不当综合征（SIADH）和自由水中毒均被认为是可能的解释。我们描述了一名19岁女性，在使用摇头丸1天后因精神状态改变就诊于急诊科。她最初的血清钠浓度为121 mmol/L，头部计算机断层扫描（CT）显示脑水肿。她接受了高渗盐水治疗及液体限制，在接下来的24小时内血清钠升至132 mmol/L。她在就诊后48小时内完全恢复意识，且康复顺利。本文讨论了摇头丸毒性，尤其是摇头丸所致低钠血症的病理生理学及治疗。
