Clinical effect of ethanol co-use in patients with acute drug toxicity involving the use of central nervous system depressant recreational drugs. (8th April 2022)

• Record Type: Journal Article
• Authors: Heier, Eva-Carina; Eyer, Florian; Rabe, Christian; Geith, Stefanie; Dargan, Paul I.; Wood, David M.; Heyerdahl, Fridtjof; Dines, Alison M.; Giraudon, Isabelle; Erik Hovda, Knut; Yates, Chris; Vallersnes, Odd Martin; Miró, Òscar; Liechti, Matthias E.; Zellner, Tobias
• Other Names: Anand Lukasz author non-byline.; Waldman Wojciech author non-byline.; Anseeuw Kurt author non-byline.; Gillebeert Johan author non-byline.; Badaras Robertas author non-byline.; Laubner, Gabija author non-byline.; Bonnici, Jeffrey author non-byline.; Brvar Miran author non-byline.; Grenc, Damjan author non-byline.; Burke Rachel author non-byline.; Moughty, Adrian author non-byline.; Caganova, Blazena author non-byline.; Galicia, Miguel author non-byline.; Gorozia Ketevan author non-byline.; Kutubidze Soso author non-byline.; Jaffal Karim author non-byline.; Mégarbane Bruno author non-byline.; Jürgens Gesche author non-byline.; Konstari Jutta author non-byline.; Liguts Viesturs author non-byline.; Stašinskis Roberts author non-byline.; Lyphout Cathelijne author non-byline.; Toth Ibolya author non-byline.; Noseda Roberta author non-byline.; Ceschi Alessandro author non-byline.; O'Connor Niall author non-byline.; Sopirala Radhika author non-byline.; Paasma Raido author non-byline.; Perez Juan Ortega author non-byline.; Puiguriguer Jordi author non-byline.; Perminas Marius author non-byline.; Surkus Jonas author non-byline.; Persett Per Sverre author non-byline.; Põld Kristiina author non-byline.; Radenkova-Saeva Julia author non-byline.; Rulisek Jan author non-byline.; Vigorita Federico author non-byline.; Waldman Wojciech author non-byline.; Waring W. Stephen author non-byline.; Zacharov Sergej author non-byline.; Schmid Yasmin author non-byline.; Liakoni Evangelia author non-byline.; Scholz Irene author non-byline.; Gesnigt Femke MJ. author non-byline.; Sandel Maro H. author non-byline.; Nitescu Gabriela Viorela author non-byline.; Calýskan Feriyde author non-byline.; Hengel-Koot Irma van den author non-byline.; Hondebrink Laura author non-byline.;
• Is Part Of: European journal of emergency medicine. Volume 29:Number 4(2022)
• Page Start: 291
• Page End: 300
• Publication Date: 2022-04-08
• Subjects: central nervous system depressants -- drug abuse, ethanol -- gamma-butyrolactone -- gamma-hydroxybutyrate -- opioids; Emergency medicine -- Europe -- Periodicals; Medical emergencies -- Europe -- Periodicals; Emergency medical services -- Europe -- Periodicals; Emergencies -- Europe -- Periodicals; Emergency Medical Services -- Europe -- Periodicals; Emergency Medicine -- Europe -- periodicals; 616.025
• DOI: 10.1097/MEJ.0000000000000932
• Languages: English
• ISSNs: 0969-9546

Abstract

Abstract : Background and importance: Patients who use recreational drugs frequently co-ingest ethanol, which is considered a central nervous system (CNS) depressant. The clinical relevance of this in acute toxicity involving other CNS depressants is not well described. Objective: To assess the clinical impact of ethanol co-use in patients presenting to the emergency department (ED) with acute toxicity involving the use of CNS depressant drugs. Design, settings and participants: A retrospective multicentre study using data from the Euro-DEN Plus database from January 2014 to December 2019. Outcomes measure and analysis: Comparison of epidemiologic and clinical characteristics, ED and hospital management of patients with CNS depressant intoxication with or without ethanol co-use. Main results: Although 7644 (17.5%) of the 43 633 presentations were included, ethanol was co-ingested in 3811 (49.9%). In total 53.3% required medical treatment, 14 patients died. Patients with ethanol co-use more frequently presented with a Glasgow Coma Scale (GCS) ≤8 (34.1% vs. 22.4%; P < 0.001), vomiting (8.1% vs. 4.6%; P < 0.001), anxiety (12 % vs. 6.4%; P < 0.001), agitation/aggression (22% vs. 14.7%; P < 0.001), seizures (3.8% vs. 2.4%; P < 0.001) and hypotension (7.5% vs. 4.6%; P < 0.001). They more often required ambulance transport (85.5% vs. 76.5%; P < 0.001), medical treatment (57.3% vs. 48.0%; P < 0.001), hospitalization (27.7% vs. 18.9%; P < 0.001), and admission to intensive care (12.2% vs. 4.0%; P < 0.001). Subgroup analysis showed that GCS ≤8 was particularly common in patients who combined ethanol with opioids or gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL). Conclusion: Co-use of ethanol with CNS-depressant drugs appears to increase the risk of adverse effects and is associated with a higher need for medical treatment, especially when ethanol is combined with opioids or GHB/GBL.