Water, Hyponatremia, MDMA & Heat Stroke: How Not to Die

 

By Terry Gotham

Now that the summer festival season is in full swing and we’ve all been dripping with sweat once at least once, it’s time to have a little chat. If you’re one of the people who hasn’t pissed clear at a festival since Dubya was president, this is 100% for you. If you’re the person in your circle that hounds everyone else to stay hydrated and eat salty snacks Wednesday morning on playa, this is also 100% for you. For this edition of Do No Harm, I spoke to Dr. Daniel E. Rusyniak, Professor of Emergency Medicine & Adjunct Professor of Pharmacology/Toxicology and Neurology at the IU School of Medicine. He dropped a pile of knowledge, so I’m going to be able to walk you through what happens to your body when you roll your face off. Down to the hormonal level, putting yourself at risk for heatstroke & hyponatremia. And of course, also illustrate how to NOT do that.

In your body, there’s this antidiuretic hormone called Vasopressin, also known as ADH. ADH’s job is to ensure your body retains water (hence it being known as an antidiuretic), and to constrict blood vessels. By increasing the water pemeability of the kidneys, it plays a key role in keeping your fool ass hydrated. When it’s heavily secreted, your kidneys get the signal to fast track water reabsorption & pissing yellow. This happens in a few complicated ways you can read about here. Guess what MDMA happens to affect?MDMA, along with many of the novel psychoactive substances taken at festivals, regional burns, and EDM shows can be grouped in the term “amphetamines and stimulants.” Which have the much desired effect of decreasing fatigue, especially fatigue you generate from exertion. You know, that thing you’re actively taking drugs to ignore?  Kind of like missing red flags on date 3 & 4, ignoring warning signs from your cardiovascular systems can have disastrous effects on your health.

Fatigue is crucial in preventing heat stroke. The reason this signal is being sent, is to keep your temperature from spiking too high. The thing that everyone forgets about amphetamine use is that it doesn’t actually give you super powers. The fact that you’re getting tired more quickly in hot environments is a warning/break point signal to your body/mind that you’re being fatigued.  When sober, mammals reach a point of exertional fatigue and maximum temperature, at which point you begin to tap out.  Guess what amphetamines & stimulants do?

By allowing you to push past your operational limits, stimulants turn you from a person who will collapse before overheating into a person with a non-trivial risk of doing the exact opposite of that. The perfect storm Dr. Rusyniak described could be used for most, if not all of the MDMA death at festivals in recent years, especially the ones at New York City’s Electric Zoo.

The summer outdoor dance party is therefore the perfect condition for exertional heat stroke to occur. Warm environment (decreasing heat dissipation), increased exertion (dancing), use of drugs that blunt normal protective responses to exertional heat stroke.
~Daniel E. Rusyniak, MD (Medical Director of the Indiana Poison Center)

The problem is exacerbated by the fact that most usual methods for rapidly cooling MDMA users may not be applicable. That person sweating their face off/rolling so hard you can see them chewing the inside of their mouth off from 15 feet away, is probably not giving up his spot in the crowd to get water. Even if he did, especially on day 2 or 3 of the festival, hyponatremia becomes a real risk. Exertion when you’ve not had zero calories, zero sleep and a cocktail of uppers and downers amplifies this risk . This is the reason why smart festivals hand out Gatorade & salty snacks after day 1. This stuff isn’t rocket science, but it does need to be planned ahead and there are plenty of ways to mess it up if you’re not careful.

There are two other wildcards to the MDMA experience. At higher doses (you know who you are), MDMA has been seen to cause cutaneous vasoconstriction. This vasoconstriction increases your blood pressure and can hamper heat release at the same time it raises your temperature. You’ll feel exceptionally hot, and then drink a ton of water, amplifying your risk for hyponatremia. It’s very hard to troubleshoot what’s going on in your cardiovascular system when you’re running a 101 degree temperature in the middle of the dance floor during a Steve Aoki set.

The idea that you can actually overheat is real, verified science, and we need to stop pretending is a myth. It can happen and when you go hard, it’s much more likely. Take breaks, don’t party in direct sunlight for 15 hours a day (you know who you are), and try to be as consistent as you can with water. On playa, Piss Clear is well known, but I think Piss Clear Regularly, should become as important. Drink water consistently, starting early in the day, before you start feeling faint. This way, you’re not fucked up thinking you have to drink a gallon of water when your anxiety spikes and you start telling your friends you feel like you’re dying.

It’s important to build good habits that don’t involve your limits, because when you’re on stimulants of whatever that shady dealer is peddling as the purest molly this week, you might just forget they exist. Additionally, you’re not a varsity or high performance athlete. While it’s been shown that marathon runners and athletes can be cooled from temperatures exceeding 107 degrees, let’s not pretend that any festival will ever have the capacity for you to consider that a way to justify being irresponsible. If you’re LeBron, you can expect a cold water bath and sodium testing on game day; you better expect an hour wait for water and impure drugs. If you’re not LeBron, please follow these simple tips:

  • If a festival or party allows Camelbaks, BPA-free reusable water bottles or any form of BYOW, take advantage of it.
  • Know where the free water stations are at any festival. If you’re at a festival or party that doesn’t have free water, berate them on social media until they have them. Don’t pay for parties that don’t have readily accessible water.
  • If you’re one of those people who use repetitive motions when rolling to de-stress, attempt to build a habit of reaching for your Camelbak nib and taking water as one. That’s way less damaging than finding people to date or smoking cigarettes in response to the jagged energy.
  • Salty snacks and food with savory tastes are your friend, especially after day 1 of events.
  • Alcohol + MDMA = Dehydration Bonanza. Pick one. Seriously, that’s the express train to FailVille, population you.
  • If you feel like a sweaty mess, believe yourself and go get some water. If you don’t feel like a sweaty mess and you’ve been on the dance floor for an hour in direct sunlight, GO GET SOME WATER.
  • If you’re drinking, try to have at least 8-12oz serving of water for every 2-3 drinks. If you’re drinking and dancing, make that ratio as close to 1:1 as you’re able to.
  • Don’t be embarrassed if you need to slow down, take breaks, ask for help or flag down emergency services. That’s what the staff & EMTs are there for. If you try to shrug off serious symptoms of heat stroke, you’ll still need to see EMTs…you’ll be out of commission for much much longer.
  • Taking breaks earlier on are much more rejuvenating. Giving yourself breaks every couple of hours at a multi-day event can make day 2 & 3 a lot easier than forced crashing for 4hrs because you can’t handle it anymore.

Don’t try to be a super hero y’all. The summer is long, and Dr. Rusyniak & I want to make sure every single one of you see Fall 2017 as well as your favorite DJs over the summer.