关于Hydroxybutyric Acid的原因,关于Hydroxybutyric Acid的相关知识。 To the Editor: In the review article by Snead and Gibson (June 30 issue)1 on the recreational use of -hydroxybutyric acid (GHB), it is stressed that GHB is undetectable in current toxicologic screens and that specific analyses may not be rapidly obtainable.
This should not be the case. Most biochemical genetics laboratories are familiar with the detection of GHB. The level of this compound is markedly increased in the urine of persons affected by the neurometabolic disorder succinic semialdehyde dehydrogenase deficiency and will be detected by urinary organic acid analysis. In fact, the use of GHB for the sedation of children may lead to an erroneous diagnosis of succinic semialdehyde dehydrogenase deficiency.2
Physicians who are dealing with cases of suspected GHB intoxication may not be aware of the analyses offered by biochemical genetics laboratories, because the latter are mostly affiliated with pediatric or genetic departments. Since these laboratories are accustomed to working on an emergency basis because of their role in the rapid diagnosis of potentially life-threatening metabolic diseases, they might assist in the diagnosis of acute GHB intoxication.
J?rn Oliver Sass, Dr.Rer.Nat.
Andrea Superti-Furga, M.D.
Universit?tsklinikum Freiburg
D-79106 Freiburg, Germany
sass@kikli.ukl.uni-freiburg.de
References
Snead OC III, Gibson KM. -Hydroxybutyric acid. N Engl J Med 2005;352:2721-2732.
Wolf NI, Haas D, Hoffmann GF, et al. Sedation with 4-hydroxybutyric acid: a potential pitfall in the diagnosis of SSADH deficiency. J Inherit Metab Dis 2004;27:291-293.
To the Editor: In reading the review article by Snead and Gibson regarding GHB, I am quite surprised at the limited reference to the legal, Food and Drug Administration–approved use of this agent (marketed as Xyrem by Orphan Medical) to treat the cataplectic complications of narcolepsy. In addition, no mention is made of the ongoing research into broadening the approved indications for this agent in patients with narcolepsy. As a practitioner who has prescribed this agent, I would have benefited from a discussion of the practical and theoretical aspects of prescribing GHB.
Edward R. Ringel, M.D.
MaineGeneral Medical Center
Waterville, ME 04901
To the Editor: I am surprised that in the review article on GHB, the therapeutic efficacy of GHB is not analyzed. The only mention is the brief statement in the introduction on the "limited clinical use in . . . alcoholism"; in contrast, the recreational abuse of GHB is extensively discussed. There is good evidence that GHB is useful in the treatment of alcoholism and makes differences in drug-abuse behavior.1 GHB appears to be effective both in the management of alcohol withdrawal syndrome (as effective as benzodiazepines2) and in the maintenance of long-term abstinence.3 Moreover, among treated patients with alcoholism, no case of abuse occurred with the greater fractioning of the dose.4 For these reasons, GHB has been approved for the treatment of alcohol dependence in some European countries.
Giovanni Addolorato, M.D.
Giovanni Gasbarrini, M.D.
Catholic University of Rome
00168 Rome, Italy
g.addolorato@rm.unicatt.it
References
Addolorato G, Caputo F, Capristo E, Stefanini GF, Gasbarrini G. Gamma-hydroxybutyric acid efficacy, potential abuse, and dependence in the treatment of alcohol addiction. Alcohol 2000;20:217-222.
Addolorato G, Balducci G, Capristo E, et al. Gamma-hydroxybutyric acid (GHB) in the treatment of alcohol withdrawal syndrome: a randomized comparative study versus benzodiazepine. Alcohol Clin Exp Res 1999;23:1596-1604.
Addolorato G, Cibin M, Capristo E, et al. Maintaining abstinence from alcohol with gamma-hydroxybutyric acid. Lancet 1998;351:38-38.
Addolorato G, Cibin M, Caputo F, et al. Gamma-hydroxybutyric acid in the treatment of alcoholism: dosage fractioning utility in non-responder alcoholic patients. Drug Alcohol Depend 1998;53:7-10.
To the Editor: The review of GHB by Snead and Gibson discusses only the effects of GHB in inducing coma and makes no mention of stimulant effects, such as agitation and combativeness. Our recent series of 66 consecutive patients with GHB intoxication included 40 with agitation, with or without coma effects; 21 of these patients had no evidence of cointoxicants.1 Recognition of agitation as a common manifestation of GHB toxicity is critical in order to identify a wider range of GHB users and shape discharge plans to address GHB abuse and possible addiction.
In addition, our research indicates that GHB-related compounds are more lethal than previously reported. We are currently compiling a case series of GHB-related fatalities; preliminary findings include reports of 146 deaths, 48 of which were not associated with cointoxicants. Deaths included 138 cardiopulmonary arrests, 4 drownings, 3 motor-vehicle fatalities, and 1 death due to a fire that was started while the person was GHB-intoxicated.2 Data collection is ongoing, and final results will be reported.
A detoxification protocol by Miotto and Roth contains very useful information on GHB withdrawal and treatment.3
Deborah L. Zvosec, Ph.D.
Minneapolis Medical Research Foundation
Minneapolis, MN 55419
dzvosec@hotmail.com
Stephen W. Smith, M.D.
Hennepin County Medical Center
Minneapolis, MN 55419
References
Zvosec DL, Smith SW. Agitation is common in gamma-hydroxybutyrate toxicity. Am J Emerg Med 2005;23:316-320.
Zvosec DL, Smith SW. Gamma hydroxybutyrate-related fatalities: 146 deaths. J Toxicol Clin Toxicol (in press).
Miotto K, Roth B. GHB withdrawal syndrome. Austin, Tex.: Commission on Alcohol and Drug Abuse, 2001:3-10. (文章出处：《新英格兰医药杂志》)
This should not be the case. Most biochemical genetics laboratories are familiar with the detection of GHB. The level of this compound is markedly increased in the urine of persons affected by the neurometabolic disorder succinic semialdehyde dehydrogenase deficiency and will be detected by urinary organic acid analysis. In fact, the use of GHB for the sedation of children may lead to an erroneous diagnosis of succinic semialdehyde dehydrogenase deficiency.2
Physicians who are dealing with cases of suspected GHB intoxication may not be aware of the analyses offered by biochemical genetics laboratories, because the latter are mostly affiliated with pediatric or genetic departments. Since these laboratories are accustomed to working on an emergency basis because of their role in the rapid diagnosis of potentially life-threatening metabolic diseases, they might assist in the diagnosis of acute GHB intoxication.
J?rn Oliver Sass, Dr.Rer.Nat.
Andrea Superti-Furga, M.D.
Universit?tsklinikum Freiburg
D-79106 Freiburg, Germany
sass@kikli.ukl.uni-freiburg.de
References
Snead OC III, Gibson KM. -Hydroxybutyric acid. N Engl J Med 2005;352:2721-2732.
Wolf NI, Haas D, Hoffmann GF, et al. Sedation with 4-hydroxybutyric acid: a potential pitfall in the diagnosis of SSADH deficiency. J Inherit Metab Dis 2004;27:291-293.
To the Editor: In reading the review article by Snead and Gibson regarding GHB, I am quite surprised at the limited reference to the legal, Food and Drug Administration–approved use of this agent (marketed as Xyrem by Orphan Medical) to treat the cataplectic complications of narcolepsy. In addition, no mention is made of the ongoing research into broadening the approved indications for this agent in patients with narcolepsy. As a practitioner who has prescribed this agent, I would have benefited from a discussion of the practical and theoretical aspects of prescribing GHB.
Edward R. Ringel, M.D.
MaineGeneral Medical Center
Waterville, ME 04901
To the Editor: I am surprised that in the review article on GHB, the therapeutic efficacy of GHB is not analyzed. The only mention is the brief statement in the introduction on the "limited clinical use in . . . alcoholism"; in contrast, the recreational abuse of GHB is extensively discussed. There is good evidence that GHB is useful in the treatment of alcoholism and makes differences in drug-abuse behavior.1 GHB appears to be effective both in the management of alcohol withdrawal syndrome (as effective as benzodiazepines2) and in the maintenance of long-term abstinence.3 Moreover, among treated patients with alcoholism, no case of abuse occurred with the greater fractioning of the dose.4 For these reasons, GHB has been approved for the treatment of alcohol dependence in some European countries.
Giovanni Addolorato, M.D.
Giovanni Gasbarrini, M.D.
Catholic University of Rome
00168 Rome, Italy
g.addolorato@rm.unicatt.it
References
Addolorato G, Caputo F, Capristo E, Stefanini GF, Gasbarrini G. Gamma-hydroxybutyric acid efficacy, potential abuse, and dependence in the treatment of alcohol addiction. Alcohol 2000;20:217-222.
Addolorato G, Balducci G, Capristo E, et al. Gamma-hydroxybutyric acid (GHB) in the treatment of alcohol withdrawal syndrome: a randomized comparative study versus benzodiazepine. Alcohol Clin Exp Res 1999;23:1596-1604.
Addolorato G, Cibin M, Capristo E, et al. Maintaining abstinence from alcohol with gamma-hydroxybutyric acid. Lancet 1998;351:38-38.
Addolorato G, Cibin M, Caputo F, et al. Gamma-hydroxybutyric acid in the treatment of alcoholism: dosage fractioning utility in non-responder alcoholic patients. Drug Alcohol Depend 1998;53:7-10.
To the Editor: The review of GHB by Snead and Gibson discusses only the effects of GHB in inducing coma and makes no mention of stimulant effects, such as agitation and combativeness. Our recent series of 66 consecutive patients with GHB intoxication included 40 with agitation, with or without coma effects; 21 of these patients had no evidence of cointoxicants.1 Recognition of agitation as a common manifestation of GHB toxicity is critical in order to identify a wider range of GHB users and shape discharge plans to address GHB abuse and possible addiction.
In addition, our research indicates that GHB-related compounds are more lethal than previously reported. We are currently compiling a case series of GHB-related fatalities; preliminary findings include reports of 146 deaths, 48 of which were not associated with cointoxicants. Deaths included 138 cardiopulmonary arrests, 4 drownings, 3 motor-vehicle fatalities, and 1 death due to a fire that was started while the person was GHB-intoxicated.2 Data collection is ongoing, and final results will be reported.
A detoxification protocol by Miotto and Roth contains very useful information on GHB withdrawal and treatment.3
Deborah L. Zvosec, Ph.D.
Minneapolis Medical Research Foundation
Minneapolis, MN 55419
dzvosec@hotmail.com
Stephen W. Smith, M.D.
Hennepin County Medical Center
Minneapolis, MN 55419
References
Zvosec DL, Smith SW. Agitation is common in gamma-hydroxybutyrate toxicity. Am J Emerg Med 2005;23:316-320.
Zvosec DL, Smith SW. Gamma hydroxybutyrate-related fatalities: 146 deaths. J Toxicol Clin Toxicol (in press).
Miotto K, Roth B. GHB withdrawal syndrome. Austin, Tex.: Commission on Alcohol and Drug Abuse, 2001:3-10. (文章出处：《新英格兰医药杂志》)
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