PMID- 29270322
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 2090-6420 (Print)
IS  - 2090-6439 (Electronic)
IS  - 2090-6420 (Linking)
VI  - 2017
DP  - 2017
TI  - A Case of MDMA-Associated Cerebral and Pulmonary Edema Requiring ECMO.
PG  - 6417012
LID - 10.1155/2017/6417012 [doi]
LID - 6417012
AB  - A 20-year-old female presented with confusion, generalized tonic-clonic seizures, 
      and severe hyponatremia after ingesting 3,4-methylenedioxymethamphetamine (MDMA). 
      Brain computed tomography (CT) demonstrated cerebral edema. Her hospital course 
      was rapidly complicated by respiratory failure and shock requiring intubation and 
      vasopressors. Refractory acute respiratory distress syndrome (ARDS) was diagnosed 
      which was unresponsive to conventional and salvage therapies, requiring 
      initiation of extracorporeal membrane oxygenation (ECMO), leading to 
      normalization of oxygenation parameters. Hyponatremia was corrected and the 
      encephalopathy resolved. The patient was decannulated and extubated after three 
      days. MDMA-induced hyponatremia is hypothesized to result from enhanced 
      serotonergic activity and arginine vasopressin (AVP) release in the brain leading 
      to hyperthermia-induced polydipsia and syndrome of inappropriate antidiuretic 
      hormone (SIADH) secretion. A common but often unrecognized complication of severe 
      hyponatremia is the Ayus-Arieff syndrome where cerebral edema causes neurogenic 
      pulmonary edema via centrally mediated increases in catecholamine release and 
      capillary injury. For our patient, ECMO was required for three days while the 
      hyponatremia was corrected which led to rapid clearing of the cerebral edema and 
      neurogenic pulmonary edema. This case illustrates that, in selecting patients 
      with refractory ARDS from MDMA-associated cerebral and pulmonary edema, ECMO may 
      be a temporizing and life-saving modality of treatment.
FAU - Thakkar, A
AU  - Thakkar A
AUID- ORCID: 0000-0001-7778-0752
AD  - Department of Internal Medicine, Mount Sinai St. Luke's-West Hospital, New York, 
      NY, USA.
FAU - Parekh, K
AU  - Parekh K
AD  - Division of Pulmonary, Critical Care & Sleep Medicine, Mount Sinai St. 
      Luke's-West Hospital, New York, NY, USA.
FAU - El Hachem, K
AU  - El Hachem K
AD  - Division of Nephrology, Mount Sinai St. Luke's-West Hospital, New York, NY, USA.
FAU - Mohanraj, E M
AU  - Mohanraj EM
AD  - Division of Pulmonary, Critical Care & Sleep Medicine, Mount Sinai St. 
      Luke's-West Hospital, New York, NY, USA.
LA  - eng
PT  - Case Reports
DEP - 20171115
PL  - United States
TA  - Case Rep Crit Care
JT  - Case reports in critical care
JID - 101598416
PMC - PMC5705885
EDAT- 2017/12/23 06:00
MHDA- 2017/12/23 06:01
PMCR- 2017/11/15
CRDT- 2017/12/23 06:00
PHST- 2017/08/21 00:00 [received]
PHST- 2017/11/05 00:00 [accepted]
PHST- 2017/12/23 06:00 [entrez]
PHST- 2017/12/23 06:00 [pubmed]
PHST- 2017/12/23 06:01 [medline]
PHST- 2017/11/15 00:00 [pmc-release]
AID - 10.1155/2017/6417012 [doi]
PST - ppublish
SO  - Case Rep Crit Care. 2017;2017:6417012. doi: 10.1155/2017/6417012. Epub 2017 Nov 
      15.