Li J, Stokes S A, Woeckener A
Department of Emergency Medicine, Charity Hospital, New Orleans, LA, USA.
Ann Emerg Med. 1998 Jun;31(6):723-8. doi: 10.1016/s0196-0644(98)70231-8.
We describe seven patients presenting with combination substance abuse involving gamma-hydroxybutyric acid (GHB).
During a 3 month period, we identified consecutive patients with GHB ingestion confirmed by urine mass spectrometry presenting to a high-volume urban emergency department.
All patients presented with acute delirium and transient but severe respiratory depression. With supportive care, including intubation and mechanical ventilation in four cases, normal mentation and respiratory function returned within 2 to 6 hours. None of these patients had documented seizures, and none of the four patients who received naloxone had a reversal response. This clinical observation supports previous experimental work in GHB-intoxicated human subjects demonstrating neither epileptiform changes on electroencephalography nor reversal with naloxone. Two findings are remarkable in this series. The first is the observation of a peculiar state of violent aggression present on stimulation of the GHB-intoxicated patient despite near or total apnea. The fact that patients fully recovered from this state may be the result of a previously demonstrated GHB hypoxia-sparing effect. The second is the observation of ECG abnormalities in several cases, including U waves in five patients.
Emergency physicians should be alerted to this agent, its characteristic effects, and its potential for serious sequelae including respiratory arrest and death.
我们描述了7例同时滥用包括γ-羟基丁酸（GHB）在内的多种物质的患者。
在3个月的时间里，我们确定了连续出现的经尿液质谱法确认摄入GHB的患者，这些患者前往一家繁忙的城市急诊科就诊。
所有患者均出现急性谵妄和短暂但严重的呼吸抑制。通过支持性治疗，包括4例患者进行插管和机械通气，患者在2至6小时内恢复了正常的精神状态和呼吸功能。这些患者均未记录到癫痫发作，接受纳洛酮治疗的4例患者均无逆转反应。这一临床观察结果支持了先前在GHB中毒人体受试者中进行的实验工作，该工作表明脑电图上既无癫痫样改变，纳洛酮也无逆转作用。在这一系列病例中有两个发现值得注意。第一个是观察到在刺激GHB中毒患者时，尽管患者接近或完全呼吸暂停，但仍存在一种特殊的暴力攻击状态。患者从这种状态完全恢复可能是先前证明的GHB缺氧保护作用的结果。第二个是观察到几例患者出现心电图异常，包括5例患者出现U波。
急诊医生应警惕这种物质、其特征性影响及其导致包括呼吸骤停和死亡在内的严重后遗症的可能性。
