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Water Issues with MDMA use
Dehydration, Over-Hydration & Heat Stroke
by Erowid

Overview of problem:
One of the persistant problems with MDMA use is that of the hyperthermia (heat-stroke / over-heating). Several factors add to this effect, including MDMA's pharmacological effect of increasing body temperature, the strong physical stimulation experienced by most users, and the euphoria and comfort of the experience which can cause users to overlook their level of exertion. Many Ecstasy users have been told that they need to make sure they are drinking enough water to stay on the safe side of this problem, but as a result, some users encounter the somewhat less recognized problem of over-hydration which causes hyponatremia (literally "low salt") also called "water intoxication".

The human body (as with other animals) maintains an equilibrium of electrolytes including salt in the bloodstream as part of its normal operation. Sweating causes the body to lose salt, but the primary cause of hyponatremia in Ecstasy users is drinking enormous amounts of water, which dilutes the salt in the body to a dangerous level. Unfortunately as the electrolytes get out of balance, body systems start to fail and (because of the blood brain barrier), the sufferer starts to exhibit signs of crisis such as diarrhea, over salivation, stupor, vomiting, muscle tremors, confusion, frequent urination, and other general symptoms of illness, and their brain begins to swell. This swelling is called a 'brain edema' or 'cerebral edema' and can (and does) lead to brain damage, paralysis, and death.

According to C. Haller, MD from the California Poison Control Center in San Francisco, hyponatremia (although actually rare among users) is one of the most common causes of ecstasy deaths or serious injuries. In England, perhaps the most notorious death associated with Ecstasy in the mid 90's was Leah Betts. Sadly, Leah died after taking Ecstasy for her birthday with friends and then drinking enough water to cause her death.

The dangers of drinking water obsessively while high are real. If you're drinking a lot of water, in any context, mixing in some salty snacks or drinking sport drinks will keep your salt and electrolyte levels healthier and can prevent hyponatremia. Including electrolytes in drinking water or consuming isotonic beverages or taking electrolytes/salts as supplements (at the correct levels) will likely prevent hyponatremia/water poisoning in nearly all cases. People on MDMA often do not want to eat anything, so salty snacks tend to be a ineffective option. While some people find the sugary or salty sport-type drinks unappealing, others actually prefer the sport drinks while high and say that they quench the thirst better than water. Any balanced electrolyte drink will help prevent overheating (hyperthermia) and water poisoning (hyponatremia) and are useful, experience-improving, and possibly life-saving simple products Ecstasy-users and party-organizers can include to help everyone maintain a healthy water equilibrium while dancing hard, taking stimulants, and to help curb the negative effects of obsessive over drinking.

Yet-Another MDMA FAQ Water Section Local File
An MDMA-related Water Intoxication Death (Anna Wood 1995) Local File
An MDMA-related Water Intoxication Death (Brittney Chambers 2001) Local File
Some Reports of Water Intoxication Local File

Jeremy Laurance's Article from the London Times, Nov 22 1995
E-Medicine's Hyponatremia Page
Urban 75 page on Leah Betts

Revision History #
  • v1.0 - June 26, 2000 - Erowid - First version.
  • v1.1 - Apr 14, 2011 - Erowid - Clarified comments about sport drinks.