Herbrand R, Greminger P, Schurter G, Pletscher W, Kupferschmidt H
Departement für Innere Medizin, Medizinische Poliklinik, Universitätsspital Zürich.
Praxis (Bern 1994). 2000 Aug 24;89(34):1326-30.
A 20-year-old male patient was brought to the emergency department by Emergency Medical Services after having been found unconscious. Upon arrival the patient was comatose with a GCS of 3, his vital signs were stable (with blood pressure 100/54 mmHg, heart rate 48 per minute, respiration rate 12 per minute and oxygen saturation 98% on room air). Both pupils were 3 mm, symmetric, and only minimally responsive. Approximately 2 hours after arrival the patient awoke and admitted having taken three ampoules of GHB (gamma hydroxybutyrate). GHB is a synthetic analog of gamma-amino butyric acid (GABA), a centrally inhibitory neurotransmitter. While GHB produces euphoria in low doses, small overdosing can result in severe poisoning with coma. The combination with other CNS depressants such as alcohol, opioids, and other narcotics is particularly dangerous. Physicians should be alerted to the clinical effects of GHB since abuse has become more widespread in Switzerland within the last months. In patients with unexplained coma the differential diagnosis of GHB-intoxication should be taken into consideration.
一名20岁男性患者在被发现昏迷后，由紧急医疗服务部门送往急诊科。到达时患者昏迷，格拉斯哥昏迷评分（GCS）为3分，生命体征稳定（血压100/54 mmHg，心率每分钟48次，呼吸频率每分钟12次，室内空气中氧饱和度98%）。双侧瞳孔3 mm，等大，对光反应微弱。到达约2小时后患者苏醒，并承认服用了三支γ-羟基丁酸（GHB）。GHB是γ-氨基丁酸（GABA，一种中枢抑制性神经递质）的合成类似物。低剂量GHB会产生欣快感，但小剂量过量服用可导致严重中毒并昏迷。与酒精、阿片类药物和其他麻醉品等其他中枢神经系统抑制剂合用尤其危险。由于过去几个月GHB滥用在瑞士变得更加普遍，医生应警惕GHB的临床效应。对于不明原因昏迷的患者，应考虑GHB中毒的鉴别诊断。
