VanWert Adam L, McCune Dan F, Brown Kaitlyn M, Bommareddy Ajay, Manning Dana H, Roman Crystal L
Nesbitt School of Pharmacy at Wilkes University, Wilkes-Barre, PA, USA.
St Luke's University Hospital, Bethlehem, PA, USA.
J Pharm Technol. 2014 Dec;30(6):240-243. doi: 10.1177/8755122514545518. Epub 2014 Jul 30.
Gamma-hydroxybutyrate (GHB) has been an abused and illicit substance for decades, but the antinarcoleptic medication Xyrem (sodium oxybate), the sodium salt of GHB, was approved just in 2002 for increasing wakefulness. We present a case of coma induced by co-ingestion of prescription GHB and ethanol and describe the response to naloxone treatment, by first responders, without evidence of opiate exposure. The purpose of this report is to bridge updated knowledge on GHB and ethanol pharmacology with the clinical sequence of events in a patient co-ingesting these compounds and to theorize on a potentially better pharmacological approach to narcolepsy. The patient was a 25-year-old woman with a history of narcolepsy. She suddenly collapsed at home but became transiently responsive after being administered naloxone in the ambulance. She presented to the emergency department with apnea, poor responsiveness with a Glasgow Coma Score of 7, and urinary incontinence. While undergoing intubation, the patient spontaneously and abruptly awoke. Labs were unremarkable except a blood alcohol concentration of 0.123%. The dosage of, and adherence to, GHB was unknown in this case. The case is described in light of the most recent pharmacological advancements on these co-ingestants. A conceptual dose-response curve is shown to facilitate understanding of the complex pharmacology of GHB. Approved and potential alternatives to GHB, for achieving wakefulness, are discussed. Potential new strategies should bear low to no risk of coma with accidental overdose or co-ingestion of ethanol. In addition, promising antidotes for future consideration are discussed.
几十年来，γ-羟基丁酸（GHB）一直是一种被滥用的非法物质，但GHB的钠盐、抗发作性睡病药物Xyrem（羟丁酸钠）直到2002年才被批准用于提高清醒度。我们报告一例因同时服用处方GHB和乙醇导致昏迷的病例，并描述急救人员使用纳洛酮治疗后的反应，该患者并无阿片类药物接触史。本报告的目的是将GHB和乙醇药理学的最新知识与同时摄入这些化合物的患者的临床事件序列联系起来，并推测一种可能更好的发作性睡病药理学治疗方法。患者为一名25岁有发作性睡病病史的女性。她在家中突然晕倒，但在救护车上接受纳洛酮治疗后短暂恢复了意识。她被送往急诊科时出现呼吸暂停，格拉斯哥昏迷评分为7分，反应迟钝，并有尿失禁。在进行插管时，患者突然自行苏醒。实验室检查除血液酒精浓度为0.123%外无异常。该病例中GHB的剂量和服药依从性未知。根据这些共同摄入物质的最新药理学进展对该病例进行了描述。绘制了一条概念性剂量反应曲线，以帮助理解GHB复杂的药理学特性。讨论了已批准的和潜在的替代GHB以实现清醒的药物。潜在的新策略应在意外过量用药或同时摄入乙醇时具有低昏迷风险或无昏迷风险。此外，还讨论了未来可供考虑的有前景的解毒剂。
