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medical emergency

Suspected Hyponatremia

When When headache, nausea, confusion, bloating, or seizures occur after MDMA use combined with high water intake.

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Content is undergoing medical and legal review. Changes possible.

Emergency

Call 112. Calling for help is required by law (German Criminal Code § 323c). levelll cannot promise immunity from criminal or administrative consequences.

Immediate

  1. 1. No more water. If available: salty broth, salty bread, or pretzel sticks in small amounts.
  2. 2. Call 112 if consciousness clouds, a seizure occurs, or symptoms worsen.
  3. 3. Position the person calmly, observe. No more MDMA, no stimulants.

Don't do

  • Do not try to 'flush it out' with more water — this worsens the dilution.
  • No electrolyte solutions without salt (some sports drinks are sugary but low in sodium).
  • No self-medication with diuretics — this makes the problem worse.

Hyponatremia (too low a sodium level in the blood) is an established and lethal complication of MDMA use. MDMA stimulates the release of ADH — the body retains water. Anyone who drinks liters of water on top of this dilutes the blood so severely that cerebral edema can develop.

Known fatal cases in the history of MDMA trace back to hyponatremia, not to direct MDMA toxicity. “Drink lots of water” is therefore wrong as a blanket safer-use tip.

Instead:

  • 250–500 ml of water per hour of dancing (no more)
  • With electrolytes (broth, salted water, sodium tablets)
  • Breaks in a cool environment
  • With headache or nausea: do not keep drinking, but sit down and observe

Clinical care: hypertonic saline infusion. In an acute emergency, 112 is the only sensible action for a layperson — self-correction with “a bit of salt” is risky in moderate to severe hyponatremia.