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MDMA toxicity with hyponatraemic seizure — SCE Acute Medicine MCQ

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HardClinical pharmacology and poisoningMDMA toxicity with hyponatraemic seizureSCE Acute Medicine

A 23-year-old man is admitted after taking MDMA at a club. He is agitated, temperature is 40.5°C, sodium is 122 mmol/L and CK is 4,200 IU/L. He has a generalised seizure in the resuscitation room. What is the most appropriate next step in management?

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Correct answer: C — Manage airway, give benzodiazepine, actively cool and treat severe symptomatic hyponatraemia with hypertonic saline

MDMA toxicity can cause hyperthermia, seizures, rhabdomyolysis and dilutional hyponatraemia. The seizure with sodium 122 mmol/L requires emergency management including benzodiazepines, active cooling, supportive care and hypertonic saline under careful monitoring. Antipyretics do not treat drug-induced hyperthermia, and uncontrolled correction risks osmotic demyelination.

Reference: TOXBASE; BNF Sodium chloride intravenous