Röell Anna Eveline, Ramnarain Dharmanand, Kamal Rama
Intensive Care Medicine, Radboud University Medical Center, Nijmegen, NLD.
Intensive Care Medicine, Saxenburgh Medisch Centrum, Hardenberg, NLD.
Cureus. 2021 Jul 14;13(7):e16398. doi: 10.7759/cureus.16398. eCollection 2021 Jul.
The prevalence of gamma-butyrolactone/gamma-hydroxybutyric acid (GBL/GHB) use is increasing. The gravity and number of incidents with this drug are relatively high. A feared complication is addiction and its withdrawal syndrome, which can be life-threatening and is difficult to treat. We present the case of a 31-year-old man, admitted to the ICU because of accidental GBL withdrawal. The patient was tachycardic, sweaty, extremely agitated, and showed signs of psychosis. High doses of benzodiazepines, propofol, sufentanil, and quetiapine could not sedate the patient sufficiently. Dosing with pharmaceutical GHB was challenging due to severe gastric retention. As the patient developed hyperthermia and rhabdomyolysis, signs of a neuroleptic malignant syndrome (NMS), he was treated with dantrolene. After 14 days, the patient was discharged to a psychiatric clinic for further treatment. GHB affects multiple neurotransmitters and chronic use causes the up- or down-regulation of several receptors. During GHB withdrawal, the patient developed a hyperexcitable state, in which there was insufficient gamma-aminobutyric acid (GABA) (the most important inhibiting neurotransmitter) and an abundance of glutamate (the most important excitatory neurotransmitter). High-dose benzodiazepines are often advocated as the first-line treatment, but benzodiazepine resistance has frequently been reported. Therefore, treatment with pharmaceutical GHB is advised. Patients with GHB-withdrawal who have clinical signs of NMS can be treated with dantrolene because it regulates the distorted calcium secretion and affects the serotonin and cholinergic system.
γ-丁内酯/γ-羟基丁酸（GBL/GHB）的使用 prevalence 正在增加。这种药物导致的事件的严重性和数量相对较高。一种令人担忧的并发症是成瘾及其戒断综合征，这可能危及生命且难以治疗。我们报告一例31岁男性病例，因意外 GBL 戒断入住重症监护病房（ICU）。患者心动过速、出汗、极度烦躁不安，并出现精神病症状。高剂量的苯二氮䓬类药物、丙泊酚、舒芬太尼和喹硫平都无法充分使患者镇静。由于严重的胃潴留，给予药用 GHB 进行 dosing 具有挑战性。随着患者出现高热和横纹肌溶解，这是神经阻滞剂恶性综合征（NMS）的症状，他接受了丹曲林治疗。14天后，患者出院前往精神病诊所进行进一步治疗。GHB 影响多种神经递质，长期使用会导致几种受体的上调或下调。在 GHB 戒断期间，患者出现了过度兴奋状态，其中γ-氨基丁酸（GABA，最重要的抑制性神经递质）不足，而谷氨酸（最重要的兴奋性神经递质）过量。高剂量苯二氮䓬类药物常被提倡作为一线治疗，但经常有苯二氮䓬类药物耐药的报道。因此，建议使用药用 GHB 进行治疗。有 NMS 临床症状的 GHB 戒断患者可用丹曲林治疗，因为它能调节扭曲的钙分泌并影响血清素和胆碱能系统。
