Chin R L, Sporer K A, Cullison B, Dyer J E, Wu T D
Department of Emergency Services, San Francisco General Hospital, CA, USA.
Ann Emerg Med. 1998 Jun;31(6):716-22.
To describe the clinical characteristics and course of gamma-hydroxybutyrate (GHB) overdose.
We assembled a retrospective series of all cases of GHB ingestion see in an urban public-hospital emergency department and entered in a computerized database January 1993 through December 1996. From these cases we extracted demographic information, concurrent drug use, vital signs, Glasgow Coma Scale (GCS) score, laboratory values, and clinical course.
Sixty-one (69%) of the 88 patients were male. The mean age was 28 years. Thirty-four cases (39%) involved coingestion of ethanol, and 25 (28%) involved coingestion of another drug, most commonly amphetamines. Twenty-five cases (28%) had a GCS score of 3, and 28 (33%) had scores ranging from 4 through 8. The mean time to regained consciousness from initial presentation among nonintubated patients with an initial GCS of 13 or less was 146 minutes (range, 16-389). Twenty-two patients (31%) had an initial temperature of 35 degrees C or less. Thirty-two (36%) had asymptomatic bradycardia; in 29 of these cases, the initial GCS score was 8 or less. Ten patients (11%) presented with hypotension (systolic blood pressure < or = 90 mm Hg); 6 of these patients also demonstrated concurrent bradycardia. Arterial blood gases were measured in 30 patients; 21 had a PCO2 of 45 or greater, with pH ranging from 7.24 to 7.34, consistent with mild acute respiratory acidosis. Twenty-six patients (30%) had an episode of emesis; in 22 of these cases, the initial GCS was 8 or less.
In our study population, patients who overdosed on GHB presented with a markedly decreased level of consciousness. Coingestion of ethanol or other drugs is common, as are bradycardia, hypothermia, respiratory acidosis, and emesis. Hypotension occurs occasionally. Patients typically regain consciousness spontaneously within 5 hours of the ingestion.
描述γ-羟基丁酸（GHB）过量的临床特征及病程。
我们收集了1993年1月至1996年12月间在一家城市公立医院急诊科就诊并录入计算机数据库的所有GHB摄入病例的回顾性系列资料。从这些病例中，我们提取了人口统计学信息、同时使用的药物、生命体征、格拉斯哥昏迷量表（GCS）评分、实验室检查值及临床病程。
88例患者中61例（69%）为男性。平均年龄为28岁。34例（39%）涉及同时摄入乙醇，25例（28%）涉及同时摄入另一种药物，最常见的是苯丙胺类。25例（28%）GCS评分为3分，28例（33%）评分在4至8分之间。初始GCS为13分或更低的非插管患者从初次就诊到恢复意识的平均时间为146分钟（范围16 - 389分钟）。22例患者（31%）初始体温为35℃或更低。32例（36%）有无症状性心动过缓；其中29例初始GCS评分≤8分。10例患者（11%）出现低血压（收缩压≤90mmHg）；其中6例患者同时伴有心动过缓。对30例患者进行了动脉血气分析；21例患者PCO2≥45，pH值在7.24至7.34之间，符合轻度急性呼吸性酸中毒。26例患者（30%）有呕吐发作；其中22例初始GCS评分≤8分。
在我们的研究人群中，GHB过量的患者意识水平明显降低。同时摄入乙醇或其他药物很常见，心动过缓、体温过低、呼吸性酸中毒及呕吐也很常见。低血压偶尔发生。患者通常在摄入后5小时内自发恢复意识。
