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Hyponatremia ("Water Intoxication")


(Photos are from the BBC.)



The ultimate price for minor ignorance...

     Yet another story, but this time, from a single real case. The girl's name is Leah Betts, a British teenager. The photo on the left shows Leah in happier times. The photo on the right shows her in the hospital, shortly before being declared brain dead and taken off life support. The official press story (and national anti-Ecstasy ad campaign that followed) was that she had been struck dead by a single ecstasy pill. The truth was more complicated (the truth usually is), and if anything, even more troubling:

     It is Leah's 18th birthday. She and her friends have decided to celebrate with a little chemical help. Or a lot of it, as the case may be. Leah has taken 'ecstasy' on at least four prior occasions, and is familiar with drugs, as are her friends. As the party progresses, Leah drinks at least several alcoholic beverages, smokes some pot, and takes a pill of 'ecstasy', as do a number of her friends.

     Leah begins to experience something that many drug users will run into at some point in their lives: Anxiety/panic...what LSD users might call a 'bad trip'. She starts to worry that something is wrong. She's heard about heatstroke deaths from the (often hysterical and inaccurate) popular press, and thinks that the way to stay safe while on MDMA is to drink plenty of water. Driven by panic and misinformation, she drinks water. A lot of water. According to her friends, nearly two gallons (7 liters) in about an hour and a half.

     Now something really is wrong; Her head hurts, and she's becoming unresponsive. All that water has diluted her blood; sodium levels are dropping (hyponatremia means 'low salt') and osmotic pressure on the rest of her tissues is increasing, forcing water into them. For many organs this wouldn't be an overly dangerous situation; they would just swell up a bit. But the brain doesn't have that option. Trapped within the skull, swelling increases pressure on the brain. Eventually, crushing pressures build up. Blood vessels begin to tear, and bleeding within her brain begins. By the time they get Leah to the hospital, it's too late. Her body is kept alive on a respirator, but there is massive, irrecoverable brain damage. Her parents are called in and given the bad news: There is no hope of recovery. The body is still alive, but her brain has been essentially destroyed. Leah's funeral is held two weeks later.


Behind the tragedy...

     The basic lesson is clear enough: Water is not an antidote to MDMA, and taken to extremes, could prove lethal. Drinking water is about dealing with dehydration related to dancing, and doesn't inherently have anything to do with MDMA; it cannot help you with a bad psychological reaction. (See Heatstroke for advice on water consumption and dancing.)

     Although you can endanger yourself by forcing yourself to drink large amounts of water while sober, there's an extra twist when dealing with MDMA: Antidiuretic hormone. MDMA places a stress on your system, and one of your body's responses to this stress is to release a chemical that tells the kidneys to allow more of the water they collect to escape back into the bloodstream.[1] As a result, while on MDMA you usually don't have to go to the bathroom for several hours, as the volume of urine being produced is greatly reduced. (The kidneys keep working, they just send less water on to the bladder.) This odd effect can remove what would normally be the main line of defense against hyponatremia: The ability to urinate out at least part of the excess water. As noted in Heatstroke, users who are not dancing or otherwise exerting themselves for extended periods don't need a plan; just drink as you normally would or as thirst dictates. If active, up to a liter of water (or better yet, sports drinks like Gatorade) per hour of heavy exercise is appropriate. These hyponatremia deaths occur because people misunderstood the problem; such tragedies should be very easily avoided.

     A note on hyponatremia: It doesn't necessarily require drinking far too much water. Endurance athletes will sometimes suffer hyponatremia because of all the salt they've lost in sweat. However, cases severe enough to be fatal seem to always be the result of uncontrolled water intake. The ideal solution for athletes are drinks that replace sodium as well as water...if you wish, you can add a little table salt (perhaps a quarter of a teaspoon per liter) to your drinking water.


Who killed Leah?

     Following her death, her father called for the person who had sold them the drugs to be charged with murder and hung. An understandable passion, but not logical...Leah's friends had taken the same pills (as no doubt had many others) and were fine. So, who killed Leah Betts? In a very real way, the Prohibitionists did.

     For one minute's good advice, her life could have easily been saved. The government has known about such cases for years, yet they have done absolutely nothing to warn the users or the public. Indeed, they've done just the opposite, repeatedly trying to hide the cause of such deaths in order to make drug use appear to just randomly kill people for no particular reason.  My question to those of you who support prohibition in its current form is simple: Was it worth it?



On to Neurotoxicity...

[1] Henry JA, Fallon JK, Kicman AT, Hutt AJ, Cowan DA, Forsling M "Low-dose MDMA ("ecstasy") induces vasopressin secretion", Lancet 1998; 351(9118):1784. Abstract