MA-HUANG STRIKES AGAIN - EPHEDRINE NEPHROLITHIASIS

Ephedrine and its metabolites are naturally occurring alkaloids that c an be derived from evergreens worldwide and have been used as medicina ls for hundreds of years. Because they have ''real'' pharmacological a lpha and beta catecholamine effects and are ''natural'' products, the alternative medicine industry has popularized them for multiple uses, Including asthma, weight loss, energy and sexual enhancement, and euph oria. Several recent reviews have documented the dangerous nature of u sing 'these ''drugs'' unsupervised, including multiple deaths, and the FDA is currently reviewing ephedrine's use in the alternative medicin e industry. We report a new toxicity, ephedrine nephrolithiasis, in a patient using an energy supplement, Ma-Huang extract, which contains e phedrine. Although previously not reported, the Louis C. Herring and C ompany kidney stone database show that this is an endemic complication of ephedrine with hundreds of previous episodes. Using gas chromatogr aphy (GC) mass spectrometry, we were able to positively identify the c hemical structure of bur patient's stone, as well as other similar sto nes from Louis Herring, as containing ephedrine, norephedrine, and pse udoephedrine. (C) 1998 by the National Kidney Foundation, inc.