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Case report
Hyponatraemia and cerebral oedema due to a modafinil overdose
  1. Rohan Oliver Kandasamy1,
  2. Viktorija Kaminskaite2 and
  3. Felix May1
  1. 1Brain Injury Rehabilitation Unit, North Bristol NHS Trust, Bristol, Avon, UK
  2. 2Medical Student, University of Exeter Medical School, Exeter, Devon, UK
  1. Correspondence to Dr Rohan Oliver Kandasamy; rohan.kandasamy{at}gmail.com

Abstract

Modafinil is a non-amphetamine stimulant that is prescribed for narcolepsy-associated sleepiness as well as reported off-licence uses among university students looking to improve wakefulness and focus. There is limited information in the medical literature about supratherapeutic modafinil dosage, symptomatology and management of overdose. We report a case of a healthy 32-year-old man who was found unconscious, having vomited, with an empty modafinil blister strip. At the emergency department, he presented with reduced Glasgow Coma Scale and prolonged episodes of vomiting. This acute presentation was conservatively managed in the intensive care unit. Antibiotics were also given for a suspected aspiration pneumonia. CT of the head showed cerebral oedema and biochemistry investigations revealed hyponatraemia. Result aetiology was unclear, however, it has been theorised to be secondary to a sizeable modafinil overdose.

  • poisoning
  • coma and raised intracranial pressure
  • drugs: CNS (not psychiatric)
  • drug misuse (including addiction)
  • unwanted effects / adverse reactions
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Footnotes

  • ROK and VK are joint first authors.

  • Twitter @Viktorija__K

  • Contributors ROK and VK contributed equally to this paper. ROK gathered initial clinical information, contributed to article writing and synthesised the differential diagnosis. VK performed a literature review and wrote the bulk of the article. Their contributions, though in different specific components of the work, were equitable overall. FM provided the initial inspiration, collected follow-up data, liaised with the patient and other clinical team members, and oversaw article writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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