HCPLive Network

Hyponatremia Clinical Update, July 15, 2011

Seizures and Hyponatremia Related to Ethcathinone and Methylone Poisoning
In a recent issue of the Journal of Medical Toxicology, researchers from the Université Laval in Quebec, Canada, reported on a case of ethcathinone and methylone poisoning with severe clinical toxicity. The combination of ethcathinone and methylone is a form of MDMA (ecstasy) that is legal in some countries. According to the authors, to their knowledge, this is the first case reported in the medical toxicology literature.

According to the study, a 22-year-old woman was brought to the emergency department following several episodes of tonicoclonic seizures a few hours after ingesting “legal ecstasy.”

“The patient needed intubation for recurrent seizures, and she was found to have severe hyponatremia (120 mmol/L) that was corrected with hypertonic saline. The patient’s mental status improved rapidly, and she was extubated the day following her admission. However, she developed prolonged rhabdomyolysis (CK 34.537 U/L) that required a six-day hospitalization,” the authors wrote.

The researchers argue that the seizures and the hyponatremia experienced by the patient may be explained by the MDMA-like characteristics of methylone that may induce inappropriate secretion of antidiuretic hormone mediated via the serotonin system.

“The combination of methylone and ethcatinone (both acting like serotonin reuptake inhibitors) might have contributed to neurologic manifestations compatible with serotonin toxicity, although our patient never had autonomic instability. Our patient had a prolonged period of rhabdomyolysis which may also be explained by excessive serotonin activity resulting in an increased motor hyperactivity,” the authors wrote.
They go on to note that the public has to be aware of this growing health problem, and that clinicians must report future cases of toxicity related to the use of cathinone synthetic derivatives in order to increase knowledge of these substances.


Management of Hyponatremia and Volume Contraction
Hyponatremia, the most common electrolyte imbalance seen in patients with aneurysmal subarachnoid hemorrhage, occurrs in one-third to one-half of patients. Hyponatremia may be caused by cerebral salt wasting and by the syndrome of inappropriate secretion of antidiuretic hormone or a combination of both.

Because limited data are available describing hyponatremia treatment in subarachnoid hemorrhage patients, researchers at the Mayo Clinic performed a Medline search for English-language manuscripts describing original research in the treatment for hyponatremia in patients with aneurysmal subarachnoid hemorrhage. In an article published in a recent issue of Neurocritical Care, the authors identified seven appropriate articles, three testing fludrocortisone, two hydrocortisone, and one each for hypertonic saline and 5% albumin.

“Data quality for treatment efficacy and safety were moderate for corticosteroid studies and low or very low for hypertonic saline and 5% albumin. Available data, although limited, support early treatment with corticosteroids to limit hyponatremia, with fludrocortisone causing fewer side effects,” the authors wrote in the study abstract.

Sources
Seizures and Hyponatremia Related to Ethcathinone and Methylone Poisoning
[Journal of Medical Toxicology]

Management of Hyponatremia and Volume Contraction [Neurocritical Care]



Further Reading
The start of the fall season means that around the country children are settling into their school routines. It also means cold and flu season is just around the corner, and with a particularly harsh winter predicted for parts of the country that could mean bad news for the end of 2014.
Adding the drug pertuzumab (Perjeta) to trastuzumab may give women with human epidermal growth factor receptor 2-positive metastatic breast cancer a boost in survival, according to new research presented Sunday at the annual meeting of the European Society of Medical Oncology, held from Sept. 26 to 29 in Madrid.
Obesity and inflammation in late adolescence are associated with increased risk for colon and rectal cancer in adulthood, according to a study presented at the American Association for Cancer Research's International Conference on Frontiers in Cancer Prevention Research, held from Sept. 28 to Oct. 1 in New Orleans.
Having trainee physicians review cases prior to clinic hours can reduce patient waiting times, flow times, and clinic session times, according to a study published online Sept. 16 in Pain Medicine. The management process studied was first popularized by Toyota in Japan.
Compared to other types of employees, pharmacists are not as happy, according to results from the TINYpulse employee engagement surveys.
More than 17% of new nurses leave their first job within one year of starting, according to research published online Aug. 25 in Policy, Politics, & Nursing Practice.
Study results show many patients with chronic obstructive pulmonary disease (COPD) may experience cognitive deterioration that becomes more severe as their COPD worsens.
More Reading