The 19-year-old female patient is found unconscious at a party. Bystanders report the individual imbibed a significant amount of grain alcohol and ingested several different pills, including 3,4-methylenedioxymethamphetamine. They observed the patient dancing wildly for several hours; after that, the patient disappeared and was found unconscious an hour later. Vital signs are within defined limits. Which lab result is consistent with the patient’s condition?

Question

The 19-year-old female patient is found unconscious at a party. Bystanders report the individual imbibed a significant amount of grain alcohol and ingested several different pills, including 3,4-methylenedioxymethamphetamine. They observed the patient dancing wildly for several hours; after that, the patient disappeared and was found unconscious an hour later. Vital signs are within defined limits. Which lab result is consistent with the patient&rsquo;s condition?

Accepted Answer

Sodium 121 mEq/dL. The patient who is unconscious after taking 3,4-methylenedioxymethamphetamine (MDMA or Ecstasy) likely has experienced water intoxication which causes a profoundly low sodium level. MDMA causes severe thirst that the patient attempts to quench with copious water. In the woman of childbearing age, normal hormones place the patient at increased risk for brain herniation due to cerebral edema. A high sodium level is not expected in this patient. Although the patient has decreased level of consciousness, the patient&rsquo;s vitals are within defined limits; this indicates the patient is not experiencing respiratory depression or failure, which would lead to a high PCO2. Hyperventilation is also not indicated by the patient&rsquo;s vital signs, so a low PCO2 is unlikely as well.

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