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Holden R, Jackson MA. 
“Near-fatal hyponatraemic coma due to vasopressin over-secretion after 'ecstasy' (3,4-MDMA)”. 
Lancet. 1996 Apr 13;347(9007):1052.
A 20-year-old woman took an ecstasy tablet at a 'rave' party. Previously she had used ecstasy without serious adverse effects. She experienced some unpleasant alterations of perception and was encouraged to drink a large quantity of water. She subsequently became stuporose and was incontinent of urine. She may have had a fit. She was taken to hospital. On examination 9 hours after ingestion of the tablet, she was talking unintelligibly and lying prostrate or in a Buddha-like posture with little response to pain or commands. Her pupils were dilated with a diminished light reflex. Pulse, temperature, and blood pressure were normal. Serum sodium concentration was 112 mmol/L (normal range 135-145 mmol/L). Serum osmolality was 238 mosmol/kg. Urine sodium was 112 mmol/L. Urine osmolality was 256 mosmol/kg. Plasma arginine vasopressin was 4-5 pmol/L, which is diagnostic of vasopressin excess in this context. Computed tomographic brain scan showed cerebral oedema. 3,4-methylenedioxymetamphetamine (ecstasy) was detected in urine. The patient was thought to be at imminent risk of coning. She was ventilated to decrease cerebral oedema and given mannitol and dexamethasone intravenously. 24 hours later, serum sodium was 120 mmol/L and she was extubated. By day 4, serum sodium had risen to 131 mmol/L and she had largely recovered. On the follow up 2 months later, she reported unpleasant flashbacks and anxiety symptoms but was otherwise well.
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