Hyponatremia ("Water Intoxication")
(Photos are from the BBC.) |
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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