skip to main content

MDMA-related hyponatraemia — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateToxicology and OverdoseMDMA-related hyponatraemiaSCE Acute Medicine

A 82-year-old woman presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show seizure with sodium 116 after MDMA and excess water intake. What is the most important immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Give hypertonic saline bolus for symptomatic severe hyponatraemia

The key discriminator is that seizure with sodium 116 after MDMA and excess water intake, which makes Give hypertonic saline bolus for symptomatic severe hyponatraemia the single best answer. Reverse anticoagulation where appropriate is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous calcium gluconate immediately would fit a different presentation or later stage of care. Give broad-spectrum intravenous antibiotics within one hour and Give hypertonic saline bolus are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Society for Endocrinology hyponatraemia guidance; TOXBASE