Clinical Case Study Summary of Hyponatremia
The drug MDMA, 3,4-methylenedioxymethamphetamin, commonly known as ecstasy leads to feelings of euphoria, emotional empathy, and increased energy. Hyponatremia is an electrolyte disturbance in which the sodium ion concentration in the plasma is lower than normal. Sodium is the dominant extracellular cation (positive ion) and cannot freely cross from the interstitial space into the cell, because charged sodium ions attract up to 25 water molecules around them, creating a large polar structure that is too large to pass through the cell membrane. In this study we looked at the case of one young college student who passed away from using ecstasy, as well as two other different examples from a marathon runner and a post surgical patient. One of the most serious medical complications of ecstasy abuse is related to symptomatic hyponatremia. The cause of hyponatremia seen with ecstasy is dilutional in nature and likely due to several interacting effects. Excessive water intake has been directly associated with ecstasy use. For partygoers the effects of amphetamines induce dry mouth and the sensation of thirst causing the user to over hydrate especially after a long night of dancing. For marathon runners, excess antidiuretic hormone (ADH, also known as vasopressin) can be released from the result of strenuous physical activity.
The treatment of hyponatremia depends on the underlying cause and whether the patient's blood volume status is hypervolemic, euvolemic, or hypovolemic. The movement of water and electrolytes between fluid compartments takes place by a variety of processes. Movement of water and electrolytes occurs through membranes and cell walls. In the setting of hypovolemia, intravenous administration of normal saline is usual. Euvolemic hyponatremia is usually managed by fluid restriction and treatment to abolish any stimuli for ADH secretion such as nausea. Hypervolemic hyponatremia is usually treated by addressing the underlying heart or liver failure. In the vast majority of cases, hyponatremia occurs as a result of a proportional excess of water relative to the salt level in the blood. Hyponatremia is corrected slowly in order to lessen the chance of the development of central pontine myelinolysis (CPM), a severe neurological disease involving a breakdown of the myelin sheaths covering parts of nerve cells. Chronic hyponatremia can lead to such complications as neurological impairments.
Doctors Ira Kurtz and Minhtri K. Nguyen developed a simple approach to analyzing the generation of dysnatremias. They have derived a new formula for explaining or predicting the magnitude of changes in the plasma sodium concentration in patients with dysnatremias. Based on sound principles that incorporate already established by Edelman, the formula is an effective alteration. This formula can be used to predict the effect of simultaneous changes in the mass balance of water, sodium, and potassium. The formula also allows the opportunity to identify and increase in the plasma glucose concentration on the plasma sodium concentrations in any given patient. The equation has proved itself time and time again to be extremely beneficial in clinical applications. Unlike any before it, the formula accounts for mathematically the simultaneous effects of TBW, Na+, K+, EMB, and VMB as well as the plasma glucose on sodium. With the incorporation of all of the factors accounted for into a single equation, the formula is clinically useful and vital as an explanatory appliance for the patients who suffer form dysnatremias.