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Acute poisoning with gamma-hydroxybutyrate
Insights
Gamma-hydroxybutyrate (GHB) poisoning affects many in Oslo, with half treated at emergency clinics. Hospitalized patients often show severe symptoms like coma and agitation, requiring prompt medical intervention.
Area of Science:
- Emergency Medicine
- Clinical Toxicology
- Public Health
Background:
- Gamma-hydroxybutyrate (GHB) poisoning is a significant concern, frequently managed at the primary emergency care level in Oslo.
- Understanding the clinical presentation and outcomes of GHB poisoning is crucial for effective emergency management.
Purpose of the Study:
- To describe the clinical characteristics of gamma-hydroxybutyrate (GHB) poisoning.
- To compare patients hospitalized with GHB poisoning to those discharged from the emergency department.
Main Methods:
- Retrospective registration of 329 patients diagnosed with GHB poisoning at Oslo Accident and Emergency Outpatient Clinic (October 2013 - September 2015).
- Inclusion criteria focused on cases where GHB was used as an intoxicant.
- Data collected included patient demographics, co-intoxicants, level of consciousness, and disposition (hospitalization vs. discharge).
Main Results:
- A total of 329 GHB poisoning cases were identified, with a median age of 30 years and 69% males.
- Reduced consciousness (69%), coma (14%), and agitation (36%) were common symptoms.
- Hospitalized patients (48%) were significantly more likely to be comatose (23% vs. 5%) and agitated (43% vs. 28%) compared to discharged patients.
Conclusions:
- Approximately half of GHB poisoning cases were managed solely at the A&E clinic level.
- Patients requiring hospitalization often presented with severe symptoms necessitating immediate transfer from the emergency department.
Background:
Many patients with gamma-hydroxybutyrate (GHB) poisoning are treated at the emergency primary health care (A&E clinic) level in Oslo. We describe the clinical picture of GHB poisoning and compare hospitalised patients with patients who were discharged from the main A&E clinic in Oslo.
Material And Method:
We registered retrospectively all patients with the clinical diagnosis GHB poisoning at the Oslo Accident and Emergency Outpatient Clinic from 1 October 2013 to 30 September 2015. We only included cases where GHB was taken as an intoxicant.
Results:
We found 329 cases of GHB poisoning in the period. The median age was 30 years (interquartile range 25-36 years, range 15-56 years), and 228 (69 %) of the cases were men. GHB was taken as the only intoxicant in 128 cases (39 %), combined with alcohol in 96 (29 %) and with amphetamine in 65 (20 %). Reduced level of consciousness was observed in 218 cases (69 %), coma (Glasgow Coma Scale score ≤ 7) in 43 (14 %) and agitation in 117 (36 %). Compared with patients who were discharged from the A&E clinic, the 159 hospitalised patients (48 % of the total number) were more often comatose (23 % vs 5 %, p < 0.001) and agitated (43 % vs 28 %, p = 0.008). The median observation time at the A&E clinic prior to hospitalisation was 42 minutes (interquartile range 26 min - 1 h 23 min, range 2 min - 20 h 10 min) vs 3 h 1 min (interquartile range 1 h 32 min - 4 h 42 min, range 14 min - 15 h 37 min) for those who were discharged from the A&E clinic (p < 0.001).
Interpretation:
Half of the patients with GHB poisoning were only treated at A&E clinic level. Many of those who were hospitalised had severe symptoms that quickly called for hospitalisation.