Emergency Department, Hospital Clínic, Barcelona, IDIBAPS, Barcelona, Spain.
Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom; Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Toxicol Lett. 2019 Oct 10;314:37-42. doi: 10.1016/j.toxlet.2019.07.001. Epub 2019 Jul 10.
Ethanol intake can increase the sedative effects of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), although the real clinical impact is unknown. We studied the clinical impact of the co-ingestion of ethanol in patients presenting to the Emergency Department (ED) with acute toxicity related to GHB/GBL use.
We performed a secondary analysis of the Euro-DEN Plus Registry (14 countries, 22 EDs) which includes 17,371 consecutive patients presenting to the ED with acute recreational drug toxicity over 39 consecutive months (October 2013 - December 2016). We compared the epidemiological and clinical characteristics and ED management of patients identified as presenting with acute toxicity related to lone GHB/GBL (Group A) or GHB/GBL combined with ethanol (Group B) without other concomitant drugs.
A total of 609 patients were included (age 32 (8) years; 116 women (19%); Group A: 183 patients and Group B: 426). The most common features were reduction in consciousness (defined as Glasgow Coma Score <13 points: 56.1%) and agitation/aggressiveness (33.6%). Those with ethanol co-ingestion were younger patients (Group A/B: 31.5/33.1 years, p = 0.029) and ethanol co-ingestion was associated with a lower frequency of bradycardia (23.5%/15.7%, p = 0.027) and more frequent arrival at the ED by ambulance (68.3/86.6%; p < 0.001), reduction in consciousness (58.9%/49.1%; p = 0.031), need for treatment in the ED (49.2%/60.4%; p = 0.011), use of sedatives (20.1%/12.8%; p = 0.034), admission to critical care units (22.4%/55.3%; p < 0.001), and longer hospital stay (stay longer than 6 h: 16.9%/28.4%; p = 0.003).
Co-ingestion of ethanol increases the adverse effects of patients intoxicated by GHB/GBL, leading to greater depression of consciousness, need for treatment, admission to the ICU and longer hospital stay.
乙醇摄入会增加 γ-羟基丁酸/γ-丁内酯（GHB/GBL）的镇静作用，尽管其实际临床影响尚不清楚。我们研究了在因 GHB/GBL 使用而出现急性毒性的患者到急诊科就诊时，乙醇共摄入对患者的临床影响。
我们对 Euro-DEN Plus 注册中心（14 个国家/地区，22 个急诊科）进行了二次分析，该注册中心包含了 39 个月（2013 年 10 月至 2016 年 12 月）内连续 17371 例因急性娱乐性药物毒性到急诊科就诊的连续患者。我们比较了单独 GHB/GBL （A 组）或 GHB/GBL 与乙醇联合使用（B 组）而无其他伴随药物的患者的流行病学和临床特征以及急诊科管理。
共纳入 609 例患者（年龄 32（8）岁；116 名女性（19%）；A 组：183 例；B 组：426 例）。最常见的特征是意识障碍（格拉斯哥昏迷评分<13 分：56.1%）和激动/攻击性（33.6%）。那些有乙醇共摄入的患者更年轻（A 组/B 组：31.5/33.1 岁，p=0.029），并且与较低的心动过缓发生率（23.5%/15.7%，p=0.027）和更频繁地通过救护车到达急诊科（68.3%/86.6%，p<0.001）相关，意识障碍（58.9%/49.1%，p=0.031），急诊科治疗需要（49.2%/60.4%，p=0.011），镇静剂使用（20.1%/12.8%，p=0.034），重症监护病房收治（22.4%/55.3%，p<0.001）和更长的住院时间（住院时间超过 6 小时：16.9%/28.4%，p=0.003）。
乙醇共摄入会增加 GHB/GBL 中毒患者的不良反应，导致意识障碍更严重，需要治疗、入住 ICU 和住院时间更长。
