Cargando…

Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity

BACKGROUND: γ-Hydroxybutyrate (GHB) is a drug of abuse with dose-dependent sedative effects. Systematic data on the acute toxicity of GHB from emergency department (ED) presentations over a long period of time are currently missing from the literature. The present study described the clinical featur...

Descripción completa

Detalles Bibliográficos
Autores principales: Liakoni, Evangelia, Walther, Fabio, Nickel, Christian H., Liechti, Matthias E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007834/
https://www.ncbi.nlm.nih.gov/pubmed/27581664
http://dx.doi.org/10.1186/s13049-016-0299-z
_version_ 1782451277071908864
author Liakoni, Evangelia
Walther, Fabio
Nickel, Christian H.
Liechti, Matthias E.
author_facet Liakoni, Evangelia
Walther, Fabio
Nickel, Christian H.
Liechti, Matthias E.
author_sort Liakoni, Evangelia
collection PubMed
description BACKGROUND: γ-Hydroxybutyrate (GHB) is a drug of abuse with dose-dependent sedative effects. Systematic data on the acute toxicity of GHB from emergency department (ED) presentations over a long period of time are currently missing from the literature. The present study described the clinical features of GHB toxicity. METHODS: Retrospective case series of GHB intoxications seen in an urban ED. RESULTS: From January 2002 to September 2015, 78 GHB-related intoxication cases were recorded (71 % male patients). The mean ± SD age was 29 ± 8 years. The co-use of alcohol and/or other illicit drugs was reported in 65 % of the cases. Neurological symptoms other than central nervous system depression included agitation (40 %) and clonus (21 %). The most frequent reasons for admission were coma (64 %) and agitation (23 %). The median time to regain consciousness was 90 min (range, 3–400 min). Sudden recovery was reported in 25 cases (32 %). Coma was not significantly associated with polyintoxication. Coma occurred in 77 % of the alcohol co-users and in 62 % ofthe non-alcohol users (p=0.052). The mean recovery time in comatose patients was 142 min in patients with co-use of alcohol compared with 89 min in patients without alcohol co-use (p=0.07). Alcohol co-use was not significantly associated with nausea/vomiting (p=0.07). The co-use of stimulants was not significantly associated with non-responsive coma (Glasgow Coma Scale = 3) or mean recovery time. Analytical confirmation of GHB was available in 37 cases (47 %), with additional quantitative analysis in 20 cases. The median GHB concentration was 240 mg/L (range, 8.3–373 mg/L). Intoxication was severe in 72 % of the cases. No fatalities occurred, and 72 % of the patients were discharged directly home from the ED. DISCUSSION: There were trend associations between alcohol co-use and frequency and length of coma and nausea/vomiting which did not reach the significance level (all p=0.05-0.07) but may nevertheless be clinically relevant. As the exact time of use is not always known, and co-use of other substances can affect the severity of poisoning, no definitive conclusions can be drawn regarding the association between GHB concentration and severity. CONCLUSION: Impaired consciousness and agitation were typical findings of GHB intoxication. The co-use of alcohol and/or other illicit substances is common but was not significantly associated with the severity of the intoxications in our study.
format Online
Article
Text
id pubmed-5007834
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-50078342016-09-02 Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity Liakoni, Evangelia Walther, Fabio Nickel, Christian H. Liechti, Matthias E. Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: γ-Hydroxybutyrate (GHB) is a drug of abuse with dose-dependent sedative effects. Systematic data on the acute toxicity of GHB from emergency department (ED) presentations over a long period of time are currently missing from the literature. The present study described the clinical features of GHB toxicity. METHODS: Retrospective case series of GHB intoxications seen in an urban ED. RESULTS: From January 2002 to September 2015, 78 GHB-related intoxication cases were recorded (71 % male patients). The mean ± SD age was 29 ± 8 years. The co-use of alcohol and/or other illicit drugs was reported in 65 % of the cases. Neurological symptoms other than central nervous system depression included agitation (40 %) and clonus (21 %). The most frequent reasons for admission were coma (64 %) and agitation (23 %). The median time to regain consciousness was 90 min (range, 3–400 min). Sudden recovery was reported in 25 cases (32 %). Coma was not significantly associated with polyintoxication. Coma occurred in 77 % of the alcohol co-users and in 62 % ofthe non-alcohol users (p=0.052). The mean recovery time in comatose patients was 142 min in patients with co-use of alcohol compared with 89 min in patients without alcohol co-use (p=0.07). Alcohol co-use was not significantly associated with nausea/vomiting (p=0.07). The co-use of stimulants was not significantly associated with non-responsive coma (Glasgow Coma Scale = 3) or mean recovery time. Analytical confirmation of GHB was available in 37 cases (47 %), with additional quantitative analysis in 20 cases. The median GHB concentration was 240 mg/L (range, 8.3–373 mg/L). Intoxication was severe in 72 % of the cases. No fatalities occurred, and 72 % of the patients were discharged directly home from the ED. DISCUSSION: There were trend associations between alcohol co-use and frequency and length of coma and nausea/vomiting which did not reach the significance level (all p=0.05-0.07) but may nevertheless be clinically relevant. As the exact time of use is not always known, and co-use of other substances can affect the severity of poisoning, no definitive conclusions can be drawn regarding the association between GHB concentration and severity. CONCLUSION: Impaired consciousness and agitation were typical findings of GHB intoxication. The co-use of alcohol and/or other illicit substances is common but was not significantly associated with the severity of the intoxications in our study. BioMed Central 2016-08-31 /pmc/articles/PMC5007834/ /pubmed/27581664 http://dx.doi.org/10.1186/s13049-016-0299-z Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Research
Liakoni, Evangelia
Walther, Fabio
Nickel, Christian H.
Liechti, Matthias E.
Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity
title Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity
title_full Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity
title_fullStr Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity
title_full_unstemmed Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity
title_short Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity
title_sort presentations to an urban emergency department in switzerland due to acute γ-hydroxybutyrate toxicity
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007834/
https://www.ncbi.nlm.nih.gov/pubmed/27581664
http://dx.doi.org/10.1186/s13049-016-0299-z
work_keys_str_mv AT liakonievangelia presentationstoanurbanemergencydepartmentinswitzerlandduetoacuteghydroxybutyratetoxicity
AT waltherfabio presentationstoanurbanemergencydepartmentinswitzerlandduetoacuteghydroxybutyratetoxicity
AT nickelchristianh presentationstoanurbanemergencydepartmentinswitzerlandduetoacuteghydroxybutyratetoxicity
AT liechtimatthiase presentationstoanurbanemergencydepartmentinswitzerlandduetoacuteghydroxybutyratetoxicity