[Gamma-hydroxybutyrate for treatment of alcohol withdrawal syndrome in intensive care patients. A comparison between with two symptom-oriented therapeutic concepts].
Seeing as gamma-hydroxybutyrate (GHB) and benzodiazepines interact with the GABA-transmitter system, we investigated whether GHB can replace the conventional therapy, which uses benzodiazepines in the treatment of alcohol withdrawal syndrome in ICU settings.


METHODS
42 chronic alcoholics were included in this prospective and randomized study. Following the development of alcohol withdrawal syndrome, the patients were randomly allocated to the GHB or to the flunitrazepam group. In addition to this, clonidine was administered in order to treat autonomic signs of withdrawal. In cases were hallucinations occurred, haloperidol was administered.


RESULTS
There was no significant difference in the efficacy of treatment used in the duration of mechanical ventilation and intensive care unit stay between groups. The patients in the GHB-group required significantly higher dosages of haloperidol and significantly lower dosages of clonidine. 14 out of 21 patients from the GHB-group developed hypernatriaemia and 15 out of 21 developed a metabolic alkalosis.


CONCLUSIONS
Symptoms of the autonomic nervous system were more effectively prevented by GHB as evident in the lower dosage requirement of clonidine. However, GHB may not sufficiently block the hyperactivity of the dopaminergic system or may have an hallucinogenic effect itself. This may be evident from the higher dosages of haloperidol which were necessary. Due to the latter fact, the administration of GHB cannot be recommended in all patients suffering from AWS in ICU settings.
Lenzenhuber
E
E
Klinik für Anaesthesiologie und operative Intensivmedizin, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin.
Müller
C
C
Rommelspacher
H
H
Spies
C
C
D000316:Adrenergic alpha-Agonists / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000472:Alkalosis, Respiratory / Q000139:chemically induced / Q000628:therapy; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003000:Clonidine / Q000009:adverse effects / Q000627:therapeutic use; D003422:Critical Care; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D005445:Flunitrazepam / Q000627:therapeutic use; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D006955:Hypernatremia / Q000139:chemically induced / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012978:Sodium Oxybate / Q000009:adverse effects / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
D000316:Adrenergic alpha-Agonists; D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D000431:Ethanol; D005445:Flunitrazepam; D012978:Sodium Oxybate; D006220:Haloperidol; D003000:Clonidine