Òscar Miró1, Miguel Galicia2, Paul Dargan3, Alison M Dines4, Isabelle Giraudon5, Fridtjof Heyerdahl6, Knut E Hovda6, Christopher Yates7, David M Wood3, Evangelia Liakoni8, Matthias Liechti9, Gesche Jürgens10, Carsten Boe Pedersen11, Niall O'Connor12, Gerard Markey12, Adrian Moughty13, Christopher Lee13, Patrick O'Donohoe13, Jacek Sein Anand14, Jordi Puiguriguer15, Catalina Homar15, Florian Eyer16, Odd Martin Vallersnes17, Per Sverre Persett18, Lucie Chevillard19, Bruno Mégarbane19, Raido Paasma20, W Stephen Waring21, Kristiina Põld22, Christian Rabe23, Piotr Maciej Kabata24. 1. Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain. 2. Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain. Electronic address: mgalicia@clinic.cat. 3. Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK; Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK. 4. Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. 5. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal. 6. The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway. 7. Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain. 8. Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Switzerland. 9. Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Switzerland. 10. Zealand University Hospital Roskilde Clinical Pharmacology Unit Roskilde, Denmark. 11. Department of Anaesthesia University Hospital of Zealand, Køge, Denmark. 12. Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, Republic of Ireland. 13. Emergency Department Mater Misericordiae University Hospital, Dublin 7, Republic of Ireland. 14. Department of Clinical Toxicology Medical University of Gdansk, Gdansk, Poland; Pomeranian Centre of Toxicology, Gdansk, Poland. 15. Clinical Toxicology Unit Emergency Department, Hospital Son Espases, Palma de Mallorca, Balearic Island, Spain. 16. Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 17. Department of General Practice, University of Oslo, Oslo, Norway; Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway. 18. Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway. 19. Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, France. 20. Foundation Pärnu Hospital, Pärnu, Estonia. 21. Acute Medical Unit York Teaching Hospitals NHS Foundation Trust York, UK. 22. Emergency Medicine Department North-Estonia Medical Centre Tallinn, Estonia. 23. Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Germany. 24. Pomeranian Centre of Toxicology, Gdansk, Poland; Medical University Gdansk, Department of Clinical Toxicology, Gdansk, Poland.
Abstract
OBJECTIVE: To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse. METHOD: We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes. RESULTS: We included 710 cases (83% males, mean age 31 years), representing 12.6% of the total cases attended for drug intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly during weekend, and 71.7% consumed GHB/GBL in combination with other substances of abuse, the most frequent additional agents being ethanol (50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among 15 clinical features pre-defined in the project database, the 3 most frequently identified were altered behaviour (39%), reduced consciousness (34%) and anxiety (14%). The severity ranged from mild cases requiring no treatment (308 cases, 43.4%) to severe cases requiring admission to intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases, 6.9%). No deaths were reported. In comparison with only GHB/GBL consumption, patients consuming GHB/GBL with co-intoxicants presented more vomiting (15% vs. 3%, p<0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p<0.05), a greater need for treatment (59.8% vs. 48.3%, p<0.01) and a longer ED stay (11.3% vs. 3.6% patients with ED stay >12h, p<0.01). CONCLUSIONS: The profile of the typical GHB/GBL-intoxicated European is a young male, requiring care for altered behaviour and reduced level of consciousness, mainly during the weekend. The clinical features are more severe when GHB is consumed in combination with other substances of abuse.
OBJECTIVE: To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse. METHOD: We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes. RESULTS: We included 710 cases (83% males, mean age 31 years), representing 12.6% of the total cases attended for drug intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly during weekend, and 71.7% consumed GHB/GBL in combination with other substances of abuse, the most frequent additional agents being ethanol (50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among 15 clinical features pre-defined in the project database, the 3 most frequently identified were altered behaviour (39%), reduced consciousness (34%) and anxiety (14%). The severity ranged from mild cases requiring no treatment (308 cases, 43.4%) to severe cases requiring admission to intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases, 6.9%). No deaths were reported. In comparison with only GHB/GBL consumption, patients consuming GHB/GBL with co-intoxicants presented more vomiting (15% vs. 3%, p<0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p<0.05), a greater need for treatment (59.8% vs. 48.3%, p<0.01) and a longer ED stay (11.3% vs. 3.6% patients with ED stay >12h, p<0.01). CONCLUSIONS: The profile of the typical GHB/GBL-intoxicated European is a young male, requiring care for altered behaviour and reduced level of consciousness, mainly during the weekend. The clinical features are more severe when GHB is consumed in combination with other substances of abuse.
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