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Courtesy of the Community Emergency Medical Responders Foundation which provides educational services and support directly on the streets to those in need in Tucson, Arizona.

For more info, log on to: www.c-emr.org

Meth + Heat = Death from low salt
Hyponatremia is a condition that occurs when the level of sodium in the blood is too low.
• Meth, MDMA and spice users are particularly susceptible
• Key symptoms: weakness, fatigue, nausea, memory loss, and confusion
• Make sure to seek medical help immediately if experiencing these symptoms

You’ve read the flyers for prevention: “avoid dehydration”, “drink adequate amounts of water”, “drink water — don’t wait until you feel thirsty”

Well, the first two statements (“avoid dehydration” and “drink adequate amounts of water”) constitute very solid advice. The last statement “drink water — don’t wait until you feel thirsty” used to be widely accepted, but is now considered by the latest consensus guidelines to be somewhat problematic (especially if you haven’t eaten and you’re planning on a self-medicated summer escape).

We’ll explain this in detail in a bit, but first … the impetus for today’s article came from a friend on the streets who came into Sunday’s C-EMR first aid station at the Z Mansion. Without mincing words, he walked in and loudly announced, “Why the f*** do you guys give water and Gatorade to the f***ing meth and Spice heads at the library?”

Good question. The answer comes in the form of an equation:
• Meth and/or Spice use + heat + plenty of water – adequate food = high risk of death from low levels of salt.

Here’s the explanation we promised:

“A lower-than-normal concentration of sodium (salt) in the blood” is called hyponatremia. According to the Mayo Clinic, “In hyponatremia, one or more factors — ranging from an underlying medical condition to drinking too much water during endurance sports — causes the sodium in your body to become diluted. When this happens, your body’s water levels rise, and your cells begin to swell. This swelling can cause many health problems, from mild to life-threatening.”

BTW, being homeless on the streets in Tucson during the summer IS an endurance sport. Think of our community — given prolonged daily exposure to extreme heat and near constant physical activity — as unwitting athletes trapped in an unremitting athletic event. And much like one out of every seven marathon runners (see study here), many of the homeless in Tucson suffer from hyponatremia.

What are the symptoms of a lower-than-normal concentration of sodium (salt) in the blood? According to a 2015 study published in theJournal of the American Geriatrics Society, the most common symptoms of profound hyponatremia are:
• Generalized weakness (Found in 69% of patients)
• Fatigue (59%)
• Nausea (44%)
• Disturbance of memory (36%)
• Disturbance of concentration (35%)
• Disturbed gait (31%)
• Disorientation to person, location, time, or the situation (30%)
• Vomiting (30%)
• Headache (27%)

Hyponatremia is potentially deadly and should be treated as a medical emergency. In addition, your risk for hyponatremia is even deadlier if you use:

1) Meth and/or MDMA (Ecstasy)
According to a 2006 study published in the AAPS Journal, “MDMA and METH produce other acute physiological changes such as changes in body temperature, hyponatremia, and hypertension ….”
Unfortunately, hyponatremia is not the only deadly condition caused by the combination of excess heat and meth. Per a 2016 study in the journal Clinical Case Reports, “(Methamphetamine) may cause hepatotoxicity, rhabdomyolysis, cardiotoxicity, nephrotoxicity, and neurotoxicity separately or sometimes together as multisystem toxicity, mostly as a serious condition requiring hospitalization. Nephrotoxicity generally presents as acute kidney injury, hyponatremia, and hypertension.”
But, you’re smart. You know that if you do meth or MDMA you should drink plenty of water to avoid overheating, right? Exactly. And that, according to a 2014 study published in Case Reports in Internal Medicine, is yet another reason why meth and MDMA users are prone to the deadly effects of hyponatremia. Per the study, “Users of MDMA learn to increase their oral water intake as a preventive measure for hyperthermia, resulting in potentially severe cases of MDMA-associated hyponatremia.”

The same problems are found in the use of a drug we profiled just two weeks ago. That wretched drug is:

2) Spice
According to a 2015 study published in the journal Swiss Medical Weekly, “‘Spice’ drugs have become popular alternatives to marijuana among teenagers and constitute an exceptionally large class of novel psychoactive substances …. Although the use of novel psychoactive substances mostly produces minor or moderate poisonings, serious complications occur. (Examples of these complications include) acute serotonin syndrome, hyperthermia, seizures, and hyponatremia.”

So, what can you do to avoid hyponatremia? As an endurance street athlete, start with:
• “Avoid dehydration” and
• “Drink adequate amounts of water”
Then, change the older advice (“Drink water — don’t wait until you feel thirsty”) to:
• “Drink according to thirst”

According to the 2015 Consensus Guidelines for Preventing Deaths Due to Exercise-Associated Hyponatremia, “In all cases, blanket statements that can be found on the internet such as ‘don’t wait until you feel thirsty’ make little sense for the majority of casual athletes and have the potential for disastrous consequences as they promulgate the idea that near constant fluid ingestion during athletic events is a reasonable and even necessary thing to do.”

So, what prevention techniques can an endurance street athlete use to rehydrate while preventing hyponatremia? Per the consensus guidelines, “The first is perhaps the most physiological and simple:drink according to thirst. Our thirst sensation is a finely tuned regulatory mechanism that protects plasma osmolality from rising more than a few percentage points above normal. Thus, our thirst sensation will prompt drinking and help to guard against excessive dehydration. … Overriding these mechanisms with continued volitional drinking behavior is unnecessary and potentially dangerous.”

So — when you see the C-EMRs in the blue caps handing out water downtown — take an ice cold bottle and drink it when you’re thirsty.

Together we can fight the deadly effects of dehydration and hyponatremia.

Free Bottled Water & Water Bottles at The Z

The C-EMR First Aid Clinic opens every Sunday morning at 9 am at the Z (the big, blue house at 288 North Church just north of the library). There you can pick up free bottled water and refillable water bottles. In addition, the nurses and doctors at the clinic can assess you for heat-related illness and discuss ways to help prevent this life-threatening condition.

And, Yes, Brother David Is Still Working on The Cooling Center

Just as in previous years, Brother David is hard at work setting up a cooling center where those on the streets can escape the hottest part of the day. No location has been finalized yet BUT we’ll let you know the instant we hear about it.

Find out the latest at tucsonhomeless.org

Just a reminder that you can find the latest information about food, shelter, and services for the homeless at www.tucsonhomeless.org. (And be sure to send us your from-the-street-updates so we can keep everything current. Thanks!)

Have a safe week!
C-EMR Foundation
(520) 352-9367
In case of an emergency, dial 911

Sources
Hyponatremia symptoms
Nigro, Nicole, Bettina Winzeler, Isabelle Suter-Widmer, Philipp Schuetz, Birsen Arici, Martina Bally, Claudine Blum, Roland Bingisser, Andreas Bock, Andreas Huber, Beat Müller, Christian H. Nickel, and Mirjam Christ-Crain. “Symptoms and Characteristics of Individuals with Profound Hyponatremia: A Prospective Multicenter Observational Study.” Journal of the American Geriatrics Society J Am Geriatr Soc 63.3 (2015): 470-75. Web.
(Link)
Hyponatremia definition
“hyponatremia.” McGraw-Hill Concise Dictionary of Modern Medicine. 2002. The McGraw-Hill Companies, Inc. 16 May. 2016
(Link)
Hyponatremia information

“Hyponatremia.” Mayo Clinic. Mayoclinic.org, 28 May 2014. Web. 16 May 2016.
(Link)
Hyponatremia in marathon runners
Almond, Christopher S.d., Andrew Y. Shin, Elizabeth B. Fortescue, Rebekah C. Mannix, David Wypij, Bryce A. Binstadt, Christine N. Duncan, David P. Olson, Ann E. Salerno, Jane W. Newburger, and David S. Greenes. “Hyponatremia among Runners in the Boston Marathon.” New England Journal of Medicine N Engl J Med 352.15 (2005): 1550-556. Web.
(Link)

Meth, MDMA and hyponatremia
Quinton, Maria S., and Bryan K. Yamamoto. “Causes and Consequences of Methamphetamine and MDMA Toxicity.” The AAPS Journal AAPS J 8.2 (2006)
(Link)
Gurel, Ali. “Multisystem Toxicity after Methamphetamine Use.” Clinical Case Reports Clin Case Rep 4.3 (2016): 226-27. Web.
(Link)
Chang, Julia Chia-Yu, Jiin Ger, and Chen-Chang Yang. “Late Diagnosis of MDMA-related Severe Hyponatremia.” CRIM Case Reports in Internal Medicine 1.2 (2014): Web.
(Link)

Spice and hyponatremia
Liechti, M. “Novel Psychoactive Substances (designer Drugs): Overview and Pharmacology of Modulators of Monoamine Signaling.” Swiss Med Wkly Swiss Medical Weekly (2015): Web.
(Link)

Hyponatremia and fluid intake
Rosner, Mitchell H. “Preventing Deaths Due to Exercise-Associated Hyponatremia.” Clinical Journal of Sport Medicine 25.4 (2015): 301-02. Web.
(Link)
McKinley, Michael J., and Alan Kim Johnson. “The physiological regulation of thirst and fluid intake.” Physiology 19.1 (2004): 1-6.
(Link)