DRINKING too much water after taking ecstasy really can be lethal, a study
has confirmed. The researchers have identified the substance that they believe
can lead to deadly 鈥渨ater intoxication鈥� in people who have taken the drug.
Ecstasy-related deaths are rare, but in a few highly publicised cases
clubbers have died after taking small doses of the drug. Heatstroke has been
blamed for most of these deaths. But in other cases, doctors suspect a rather
different cause of death.
One such case is that of Leah Betts, the British teenager who fell into a
coma and died after taking one ecstasy tablet in 1995. Her brain had swelled
with water, diluting the salt vital for nerve and brain cell function.
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After people have taken ecstasy, their blood contains unusually high
concentrations of vasopressin. As levels of this hormone increase, the body
retains more water.
The researchers exposed lab cultures of rat neurons from the hypothalamus to
ecstasy and a breakdown product called 4-hydroxy-3-methoxymethamphetamine
(HMMA). 鈥淲e found that HMMA is at least twice as potent at getting the
hypothalamic cell to release vasopressin,鈥� she says.
When people take ecstasy their bodies break down the drug into HMMA. The
release of vasopressin that follows boosts water retention and so dilutes the
sodium and other salts in the blood. This can damage brain and nerve tissue,
which is especially sensitive to abnormal levels of sodium in cells. 鈥淚t鈥檚
basically water intoxication,鈥� says Mary Forsling of the Centre for Neuroscience
at King鈥檚 College, who presented the results this week at the Society for
Endocrinology鈥檚 annual meeting in London.
Forsling believes the risk of this happening probably depends on the speed at
which individuals break down ecstasy鈥檚 principal ingredient, called MDMA
(3,4-methylenedioxymethamphetamine), into HMMA. 鈥淚t鈥檚 good to be a poor
metaboliser,鈥� Forsling says, but only 10 per cent of the population are
protected in this way.
The finding unmasks another risk factor for ecstasy users, says Forsling.
Women of reproductive age are already known to be most at risk of salt
starvation. High levels of oestrogen midway between periods are thought to make
the nervous system particularly vulnerable to damage from salt starvation. So
far, however, this is not reflected in the numbers of water intoxication cases,
which are split roughly 50:50 between men and women. The team notes, too, that
only one or two of the dozen or so ecstasy-related deaths that occur in Britain
each year are put down to 鈥渨ater intoxication鈥�.
鈥淢y advice is not to take ecstasy,鈥� says Forsling. 鈥淏ut if people do, they
should rehydrate themselves but be sensible in the amount they drink,鈥� she says.
Another possibility is to top up sodium levels by adding salt to bottled
water.
Drug abuse expert John Henry, one of Forsling鈥檚 co-researchers at St Mary鈥檚
Hospital, London, says that the findings show that the dangers posed by ecstasy
can vary, depending on people鈥檚 genetic make-up. 鈥淚t means that some people
metabolise more of the drug, so the risk varies between individuals,鈥� he says.