Neurogenic Stunned Myocardium Following an Attempt to Pass a Drug Test

• Type of Material: Article
• Authors: Zachary Illg, Emory University; Aya Dabaja, Henry Ford Hospital; Laura Garcia, Henry Ford Hospital; Nicole Adams, Henry Ford Hospital; Satheesh Gunaga, Henry Ford Hospital
• Language: English
• Date: 2021-09-27
• Publisher: Cureus, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Illg et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.18318
• Title of Journal or Parent Work: Cureus
• Volume: 13
• Issue: 9
• Grant/Funding Information: None declared
• Keywords: cerebral edema; extracorporeal membrane oxygenation; acute hyponatremia; neurogenic stunned myocardium; drug screen
• Research Categories: Health Sciences, Pharmacy; Biology, Neuroscience; Health Sciences, Health Care Management; Health Sciences, Public Health

Abstract

Ingestion of a large volume of free water or other hypotonic solution can cause acute hyponatremia, leading to multiorgan dysfunction. Individuals may attempt to generate a false-negative urine drug screen through increased free water consumption leading to acute hyponatremia requiring emergency medical care. We present the case of a 19-year-old male who presented to a community emergency department for altered mental status after an attempt to generate a false-negative urine drug screen. He ingested a large volume of free water and multiple detoxification solutions, causing acute hyponatremia with resultant cerebral edema and neurogenic stunned myocardium. He required extracorporeal membrane oxygenation therapy with complete recovery of neurologic and cardiac function. Acute hyponatremia from excess free water consumption is a well-documented phenomenon that all emergency providers should be aware of. Prompt identification and management of acute hyponatremia are essential to prevent potentially severe, devastating sequelae, including cerebral edema and cardiopulmonary failure.In addition, extracorporeal membrane oxygenation may be considered in patients with cardiopulmonary failure in the setting of reversible cardiomyopathy, as evidenced in our case.