Salathe Cecile, Blanc Anne-Laure, Tagan Damien
Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Pharmacie Clinique, Pharmacie des Hôpitaux de l'Est Lémanique, Vevey, Switzerland.
BMJ Case Rep. 2018 Aug 29;2018:bcr-2018-224731. doi: 10.1136/bcr-2018-224731.
Recreational drug use is a significant societal issue and remains a clinical challenge in emergency and critical care departments. We report on a 19-year-old woman admitted to hospital semiconscious and with severe hyponatraemia. Urinalysis was positive for methamphetamine and supported a diagnosis of hyponatraemia related to ecstasy use together with a syndrome of inappropriate antidiuretic hormone secretion (SIADH). The woman was transferred to an intensive care unit, where a hypertonic saline infusion was started. Three hours postadmission she developed polyuria. Follow-up urinalysis at this point was consistent with water intoxication. This case is a reminder that hyponatraemia is a potentially fatal complication after the ingestion of 3,4-methylenedioxymethamphetamine, illustrates the sequential nature of an SIADH and water intoxication and highlights the importance of considering the sequence of onset of hyponatraemia, as the patient may be admitted at any stage.
消遣性药物使用是一个重大的社会问题，在急诊科和重症监护病房仍然是一项临床挑战。我们报告了一名19岁的女性，她入院时处于半昏迷状态，伴有严重低钠血症。尿液分析显示甲基苯丙胺呈阳性，支持了与摇头丸使用相关的低钠血症诊断，同时伴有抗利尿激素分泌不当综合征（SIADH）。该女性被转入重症监护病房，在那里开始输注高渗盐水。入院三小时后，她出现了多尿。此时的后续尿液分析与水中毒一致。该病例提醒我们，摄入3,4-亚甲基二氧甲基苯丙胺后，低钠血症是一种潜在的致命并发症，说明了SIADH和水中毒的先后顺序，并强调了考虑低钠血症发病顺序的重要性，因为患者可能在任何阶段入院。
