GHB, GBL, na 1,4-Butanediol Kurenza urugero no gukuramo: Kurinda inzira no gutwara ICU¶

Gamma-hydroxybutyrate (** GHB ) hamwe na prodrugs yimiti yinganda, gamma-butyrolactone ( GBL , yagurishijwe mubucuruzi nkibikoresho bisukura ibiziga, ibyuma bisiga amarangi, cyangwa kuvanaho imisumari) hamwe na ** 1,4-butanediol ** ( 1,4-BD **, ibishishwa byinganda zikoreshwa muburyo bwa poliurethane). Azwi muri club, ibirori, chemsex, hamwe nu ruziga rwubaka umubiri nka ** "G", "Liquid Ecstasy", "Fantasy", "Gina", cyangwa "Ubururu bwa Nitro" **, aya mazi asobanutse, adafite impumuro nziza cyangwa umunyu mwinshi-isabune ifite isabune yoroheje kandi itagira umurongo. Bitandukanye n'inzoga cyangwa imiti igabanya ubukana, aho gukuba inshuro ebyiri bitera gusinzira byateganijwe, kongera amazi ya GHB cyangwa GBL ya mililitiro ** 0.5 kugeza kuri mililitiro ** gusa yuzuza metabolism y'umwijima kandi bigatera guhinduka gutunguranye kuva euphoria ukajya muri ** Glasgow Coma Scale (GCS) 3 coma **, ikunze kwitwa ** "kugwa muri G-umwobo" **. Mu minota 15 kugeza kuri 45, umuntu agira ihungabana rikomeye ryubuhumekero, Cheyne-Stokes guhumeka, bradycardia ikabije (umuvuduko wumutima ugabanuka munsi ya 40 kugeza kuri 50 kumunota), hypothermia, hamwe no kuruka kumushinga mugihe adafite rwose refleks yo gukingira. Ikirushijeho kuba kibi, GHB na GBL icyarimwe bitera kwakirwa kwakirwa bikurura intandaro zitera ubukana ** myoclonic jerks, kwifata dystonic, hamwe no kurwana mugihe cyo kuvuka **, bikunze kuyobya abarebera hamwe nabatabazi byihutirwa kugirango basuzume nabi koma hypoxique nkigicuri cyibanze cya epileptic.

Ndetse akaga gakabije kuruta kunywa birenze urugero ni ** acute GHB, GBL, cyangwa syndrome ya 1,4-butanediol yo gukuramo **, ibaho kubantu banywa "amasaha yose" (buri masaha 1 kugeza kuri 3, amasaha 24 kumunsi) kugirango birinde guhangayika. Kuberako GHB na GBL bifite ultra-bigufi ya plasma ikuraho igice cyubuzima bwiminota ** 20 kugeza 60 gusa **, kubura ikinini kimwe gitera casade yuzuye, ishobora guhitana ubuzima mumasaha ** 1 kugeza 6. Bitandukanye no gukuramo inzoga, ikora cyane cyane kuri $ inyandiko {GABA} _A $ yakira kandi igasubiza byateganijwe kuri dosiye isanzwe ya diazepam cyangwa lorazepam, gukuramo GHB biterwa no gutakaza gitunguranye ** $ inyandiko {GABA} _B $ na GHB yihariye ya reseptor tone **, bitera guturika kwa glutamate, dopinephine, na dopamine. Hatabayeho ubufasha bwihuse bwitaweho (ICU) ukoresheje benzodiazepine nini-yuzuye imitsi ihujwe na ** baclofen (itaziguye $ inyandiko {GABA} _B $ agonist), fenobarbital, propofol, cyangwa dexmedetomidine **, gukuramo GHB bikabije byiyongera cyane muri delirium, hypertacmie nini, gutabwa muri yombi. Niba uhuye nihutirwa nonaha, hamagara aho utuye nimero yihutirwa ako kanya, hanyuma ubaze abavandimwe bacu bayobora kuri gukuramo inzoga delirium ihinda umushyitsi, gukuramo benzodiazepine ibyago byo gufatwa, na gusubiramo birenze urugero kwirinda no kugabanya naloxone.

Kora ubu¶

1. ** Gerageza kwitabira no guhumeka ako kanya: niba umuntu wafashe GHB, GBL, cyangwa 1,4-butanediol adashobora gukangurwa nigituba gikomeye, arimo kuniha / gutontoma, cyangwa gufata umwuka utari munsi ya 8 kugeza 10 kumunota, hamagara numero yawe yihutirwa (911 muri Amerika / Kanada, 112 muburayi, 999 mubwongereza) NONAHA. ** Ntukareke umuntu "uryama" gufata imyanya y'ubuhumekero byica no kwifuza guceceka bibaho byihuse mugihe abari bahari bakeka ko umuntu asinziriye gusa.
2. ** Zingurura umuntu utagira ubwenge mumwanya wibumoso ugaruka hanyuma uhite uhanagura ibirutsi bigaragara mumunwa. ** GHB na GBL bihuza bidasanzwe koma yimbitse (GCS 3) hamwe na emesi itunguranye, ikomeye (kuruka). Kuryama neza inyuma bitera kuniga no guhitana imiti ya pneumonite kuko aside igifu yuzuza ibihaha.
3. ** Administer intranasal Naloxone (Narcan 4 mg) hanyuma utangire guhumeka gutabara (guhumeka 1 buri masegonda 5 kugeza kuri 6) niba guhumeka bitinda, bidakabije, cyangwa bidahari. Naloxone ikuraho neza ihungabana rya opioid mugihe guhumeka gutabara bituma ubwonko bwa ogisijeni kugeza inkeragutabara zigeze.
4. ** Ntugashyire ikintu na kimwe mumunwa wumuntu cyangwa ngo ubuze amaguru niba ubonye gutitira, kunyeganyega, cyangwa gukubitwa. Kenyera umutwe kandi ubarinde gukubita ibikoresho.
5. ** Gupima wandike ubwoko bwibicuruzwa nyabyo (GHB na GBL na 1,4-BD), ingano ya mililitiro yafashwe, igihe cyanyuma, kandi niba umuntu akoresha "24/7" (buri masaha 1 kugeza kuri 3 kumasaha).
6. ** Fata ubwoba ubwo ari bwo bwose, kubira ibyuya, umutima wiruka, paranoia, cyangwa salusitike guhera amasaha 1 kugeza kuri 6 nyuma yo guhagarika ikoreshwa rya GHB / GBL risanzwe ryihutirwa ryubuvuzi bwa ICU. kwikinisha **.

Igiti cyemezo: Gutezimbere GHB / GBL Kurenza urugero ("G-Hole") va Kubangamira Ubuzima 24/7 Gukuramo¶

Kuberako kurenza urugero bitera koma muminota mike mugihe gukuramo bitera delirium ihindagurika mumasaha, abarebera hamwe nabaganga byihutirwa bagomba kumenya byihuse icyiciro cyuburozi bwa GHB / GBL.

flowchart TD
    A["Ibihe byihutirwa birimo GHB, GBL, cyangwa 1,4-Butanediol ('Liquid G')"] --> B{"Ni uruhe rwego rw'imitekerereze n'umuntu kuva igihe cyanyuma?"}
    B -->|"Yakozwe iminota 10 kugeza saa tatu zishize: Noneho gusinzira, kunyerera, bidashoboka ('G-Hole'), kuniha, gutitira, cyangwa kuruka"| C["ACUTE OVERDOSE PHASE: Ibyago byinshi bya Apnea, Aspiration & Bradycardia"]
    B -->|"Umukoresha udakira 24/7 (dosiye buri saha 1 kugeza 3): Igipimo cyanyuma cyari 1 kugeza 12; ubu kunyeganyega, kubira ibyuya, guhangayika, tachycardic, cyangwa hallucinating"| D["ICYICIRO CY'ICYICIRO: Ibyago byinshi bya Benzo-Irwanya Delirium & Rhabdomyolysis"]
    C --> E{"Bashobora gukanguka bagahumura amaso iyo bavuganye, hamwe no guhumeka bisanzwe (> 12 / min)?"}
    E -->|"OYA: Ntibishoboka (GCS <8), guhumeka / guhumeka neza, iminwa yubururu, impiswi itinda (<50 bpm), cyangwa kuruka mugihe ucumbagira"| F["Hamagara 911/112/999 Ako kanya: 1. Kuzindukira kumwanya wo kugarura ibumoso 2. Tanga Naloxone + Impemu zo gutabara 3. Witegure Intubation ya Airway"]
    E -->|"YEGO: Kanguka, uvuge neza, guhumeka bisanzwe, ariko umutwe / isesemi"| G["Komeza wicare cyangwa ubeshye kuruhande: Kurikirana guhumeka buri minota 3 mumasaha 2 (1,4-BD cyangwa GBL irashobora gukomera bitinze); hamagara 911 niba ibitotsi byimbitse"]
    D --> H{"Barimo kwerekana ibimenyetso byubwonko cyangwa ubwigenge (guhinda umushyitsi, HR> 100 bpm, guhagarika umutima, kudasinzira, urujijo, cyangwa paranoia)?"}
    H -->|"YEGO: Ibimenyetso byose byo kwikuramo mukoresha amasaha yose (24/7)"| I["AKARERE KA BITARO / ICU BYIHUTIRWA: Ubwikorezi kuri ED Ubu; Abaganga bamenyeshe gutangira Diazepam-Dose-Baclofen (GABA-B Agonist) Porotokole"]
    H -->|"OYA: Asimptomatic nonaha, ariko ifata GHB / GBL> inshuro 3 kumunsi cyangwa buri masaha 2 kugeza 4"| J["NTIMUHagarike URUKOKO RUKonje MU RUGO: Tegura Detox Yihutirwa Yubuvuzi hamwe na Baclofen + Benzodiazepine Cross-Taper"]

Igice cya 1: Pharmacology ya Razor-Thin Margin (GHB na GBL na 1,4-Butanediol)¶

Kumva impamvu GHB, GBL, na 1,4-butanediol itera kurenza urugero kubwimpanuka bisaba gusuzuma uburyo ayo mazi atatu yitwara imbere mumyanya yumubiri, umwijima, nubwonko.

1. Indangamuntu ya Shimi na Metabolic Guhindura Inzira¶

Nubwo ibyo byose uko ari bitatu byuzuza ubwonko na ** gamma-hydroxybutyrate (GHB) **, imbaraga zabo kuri mililitiro, umuvuduko wo kwinjiza, hamwe n’imikoranire n'inzoga ziratandukanye cyane:

1. ** GHB. Mubisanzwe ni isukari isobanutse ifite ** umunyu, uburyohe bwisabune ** ($ inyandiko {Na-GHB} $). Niba bihujwe nabi na hydroxide ya sodium irenze (pH > 10 to 12), umuhanda GHB utera ** alkaline caustic yaka kumunwa na esofagus **. Igera ku rwego rwo hejuru mu bwonko muri ** iminota 20 kugeza kuri 45 **, hamwe na kimwe cya kabiri cyubuzima bwa ** iminota 20 kugeza kuri 50 **.
2. ** GBL. Bimaze kumirwa, plasma yamaraso ** lactonase enzymes (paraoxonase) ** hydrolyze GBL muri GHB muminota ** . Kubera ko GBL ibora ibinure, ikurura vuba cyane ( igera muminota 15 kugeza 30 **) hamwe na ** 100 ku ijana bioavailable yo mu kanwa ** (ugereranije na 65% kubwa GHB yo mu kanwa). Millilitiro ya mililitiro, ** 1.0 mL ya GBL yuzuye itanga GHB inshuro 1,6 kugeza kuri 2.0 ikora cyane kuruta 1.0 mL yumuhanda GHB **.
3. ** 1,4-Butanediol (1,4-BD / "BDO"): ** Umuyoboro wa diol wo mu nganda ukonjesha mu gishashara kiva kuri dogere selisiyusi 20 (dogere 68 Fahrenheit) **. Bitandukanye na GBL, ** 1,4-butanediol bisaba guhindura umwijima intambwe ebyiri **: icya mbere na ** alcool dehydrogenase (ADH) ** muri gamma-hydroxybutyraldehyde, naho icya kabiri na ** aldehyde dehydrogenase (ALDH) ** muri GHB. Kuberako Ethanol na 1,4-BD bahatanira umwijima umwe ** enzyme ya ADH **, kunywa inzoga bibuza 1,4-BD guhinduka kugeza inzoga zimaze gukuraho, kurekura bolus yatinze, yica ya GHB nyuma yamasaha.

2. Imbonerahamwe yo kugereranya: GHB na GBL na 1,4-Butanediol Clinical Toxicology¶

3. Kuki Dose-Igisubizo Umurongo ari Ikibuye (Zero-Itondekanya Kuzuza Kinetics)¶

Ku bantu bakuze bafite ubuzima bwiza, GHB ikurwaho cyane cyane na okiside mu mwijima ikoresheje ** succinic semialdehyde dehydrogenase (SSADH) ** muri acide succinic, yinjira muri cycle ya Krebs igasohoka nka dioxyde de carbone n'amazi. Nyamara, iyi nzira ya hepatike enzyme yinzira ** yuzura rwose mumaraso hejuru ya microgramu 50 kugeza kuri 60 kuri mililitiro ** (urwego rugera hafi yumuti umwe wo kwidagadura).

Iyo enzyme yumwijima imaze kuzura, kurandura GHB biva kuri ** ibyiciro byambere byateganijwe ** bijya kuri ** zeru-zeru ** (aho umwijima ushobora gukuramo gusa umubare muto wagenwe kumasaha). Kubera iyo mpamvu, mugihe ** 1.0 kugeza 1.5 mL ya GBL ** ishobora gutera euphoria, ** 2.0 kugeza kuri 2.5 mL y icupa rimwe ** (cyangwa kongera kunywa kuminota 45 aho gutegereza amasaha 3) itera urwego rwa GHB rudafite imipaka mubwonko kugeza kuri ** gatatu cyangwa kane **, guhagarika ubwenge no guhumeka.

Igice cya 2: Gucunga ibiyobyabwenge birenze urugero ("Kugwa muri G-Hole")¶

Iyo umuntu afashe urugero rwinshi rwa GHB / GBL, yongera kunywa vuba cyane ("stacking"), cyangwa avanga GHB / GBL na ** inzoga, benzodiazepine, ketamine, cyangwa opioide **, bitera imbere muminota 15 kugeza 30 binyuze mubyiciro bine byubuvuzi:

1. ** Icyiciro cya 1 (Ataxia & Slurred Speech): ** Kuzunguruka, gutakaza umunzani, gutemba, gufunga amaso, no kubira ibyuya byinshi.
2. ** Icyiciro cya 2 (Agitated Stupor & Myoclonus): ** Kwikubita hasi inshuro nyinshi, kubyuka gutangara, gutitira injyana ya amaboko / isura (** myoclonus **), cyangwa amaboko azunguza iyo akozeho.
3. ** Icyiciro cya 3 ("G-Hole" / Coma idasanzwe, GCS 3 to 6): ** Gutakaza burundu ubwenge; nta gisubizo kuri rubavu; kubuzwa (miosis) cyangwa ubunebwe bwabanyeshuri.
4. ** Icyiciro 435 to 50 bpm) **, hypothermia iri munsi ya dogere selisiyusi 35.0 (dogere 95.0 Fahrenheit) **, no guceceka bucece ibirimo igifu.

1. Kuki Kuruka Imbere ya G-Hole Nibintu Byambere Bitera Urupfu¶

Bitandukanye na opioide irenze urugero, ** GHB na GBL bikangura cyane dopamine hamwe na reseptor ya emetike mukarere ka postrema MU GIHE CYANE BIKURIKIRA Gag ya pharyngeal na cough reflexes **. Kugera kuri ** 30 kugeza kuri 50 ku ijana bya comatose GHB / GBL abarwayi barenze urugero baruka mugihe nta ubwenge bafite (GCS 3) **.

Niba inshuti ishyize umuntu wa comatose kumugongo kuri sofa cyangwa kuryama kugirango aryame, aside igifu na pisine yibiribwa mumuhogo kandi bigahumeka neza mubihaha byombi (** aspiration **), bigahita biniga cyangwa byica ** Mendelson chimique pneumonitis hamwe na Syndrome ya Acute Respiratory Distress Syndrome (ARDS) ** nyuma yamasaha.

** Ako kanya Gahunda yo Kurokora Ubuzima Kurokora: **

1. ** Zingurura umuntu kuruhande rwibumoso (Umwanya wibumoso ugaruka): ** Ongera ukuboko kwi bumoso kuruhande rwiburyo, uhekenya ivi ryiburyo hasi kugirango badashobora kuzunguruka mumaso cyangwa inyuma, hanyuma ushire ukuboko kwi buryo kwi munsi yumusaya wiburyo.
2. ** Shyira umusaya imbere hanyuma uzenguruke umunwa umanuke werekeza hasi: ** Imbaraga rukuruzi ziva amacandwe hanyuma ziruka hasi aho kumanuka muri trachea mugihe ururimi rutagaragara inyuma yumuhogo.
3. ** Kora urutoki rwa kashe yohanagura GUSA niba bigaragara ko kuruka gukomeye guhagarika umunwa: ** Ntukigere uhumura buhumyi mu muhogo.

2. Kuki GHB irenze urugero itera "Gufata Impimbano" (Myoclonic Jerks & Combativeness)¶

Umurwayi wa comatose cyane GHB / GBL (GCS 3) kenshi kunyeganyega, kunyeganyeza amaboko, gufunga urwasaya, cyangwa gukubita cyane mbere yo gusubira mu mutuzo. Ubushuhe buke bwa GHB butera presinaptic zishimishije ** reseptor ya GHB ** kandi bigahagarika imiyoboro ya thalamic-cortical (itanga ** myoclonus **), mugihe imbaraga nyinshi zitera inzitizi ** $ inyandiko {GABA} _B $ yakira **. Mugihe urwego rwubwonko rurenze iyi mbago, umuntu agira ** amajerekani menshi ya myoclonic jerks ** na ** kugaragara delirium ("G-kurwana") **.

Ntugakore ** ntugumane umuntu kumugongo, ntukore ** ntugashyire ibintu hagati y amenyo yabo, na ** inkeragutabara zimenyesha ko gutereta biva muburozi bwa GHB / GBL **. Mu bitaro, abaganga byihutirwa birinda kurenza urugero umurwayi wa GHB udashidikanywaho na benzodiazepine yinjirira mu mitsi ya myoclonic, kuko kongeramo diazepam cyangwa lorazepam hejuru ya GHB bishobora guhindura guhumeka kumupaka no gufatwa nubuhumekero bwuzuye.

3. "Gukanguka kwa Lazaro" n'impamvu abarwayi batagomba gusohoka muri ER hakiri kare¶

Mu kunywa birenze urugero bya GHB cyangwa GBL, umwijima umaze gukuraho ibiyobyabwenge bihagije (mubisanzwe ** amasaha 2 kugeza kuri 5 ** nyuma yo gufatwa), umurwayi ahura na ** "Lazaro" **: muminota ** 10 kugeza 15 min **, umurwayi wari comatose (GCS 3) mu buryo butunguranye bahumura amaso, aba maso (GCS 15), agasaba gutaha. Kuva mu bitaro ako kanya ni akaga kubera impamvu eshatu:

1. ** Gutinda 1,4-Butanediol + Guhindura Inzoga: ** Umuhengeri wa kabiri wo guhindura GHB urashobora gutera mugihe udahinduwe na 1,4-BD ugumye mu mwijima.
2. ** Guceceka guceceka Pneumonitis: ** Abarwayi barutse mugihe comatose bisaba amasaha 6 yo kugenzura ibyuzuye bya ogisijeni no gufata amashusho mu gatuza kugirango birinde gukomeretsa ibihaha.
3. ** Igisasu cyo gukuramo 24/7: ** Kubakoresha bakoresha amasaha yose, kubyuka birenze urugero bivuze ko amaraso ya GHB yakubise zeru; muri ** iminota 60 kugeza 180 180 **, barashobora kwibira muri ** acute GHB yo gukuramo delirium **.

Igice cya 3: Indwara Yangiza GHB / GBL / 1,4-BD Gukuramo Indwara¶

Mugihe "G-umwobo" ikaze ishobora kwica mugihe cyiminota 30 binyuze mukubuza guhumeka, ** gukuramo GHB / GBL ni ikibazo cyigihe kirekire, hyper-metabolic medical medical itwara umubare wimpfu zanduye ugereranije n’inzoga zikomeye zitavuwe Delirium Tremens (DTs) **, nyamara ikura ** inshuro enye kugeza umunani zihuta **.

1. Ninde ufite ibyago byo gukuramo cyane? ("24/7" Umutego wo Kunywa)¶

Kuberako GHB na GBL bishira burundu mumasaha 2 kugeza kuri 3, abayikoresha basanzwe bahita babona ko uko buri dose igenda ishira, bahura nubwiyongere bwa ** dopamine na glutamate ** ("G-rebound"): kubyuka saa tatu za mugitondo numutima wiruka, kudasinzira cyane, ubwoba, no kubira ibyuya. Kugirango uryame nijoro kandi ukore kumanywa, umuntu atangira kunywa ** buri masaha 1.5 kugeza kuri 3 kumasaha ("24/7 dose") **.

** Ivuriro ritukura-Ibendera ryibipimo byo Kwishingikiriza Kumubiri: **

• ** Kunywa inshuro: ** Gufata GHB, GBL, cyangwa 1,4-butanediol ** inshuro zirenze 4 kugeza kuri 6 kumunsi **, cyangwa ** buri masaha 1 kugeza kuri 4 kumasaha (harimo kubyuka nijoro gufata "ibitotsi") ** mugihe kingana na ** 2 kugeza 4 byikurikiranya **.
• ** Umubare wuzuye wa buri munsi: ** Koresha garama zirenga ** 15 kugeza kuri 25 za GHB kumunsi ** cyangwa zirenga ** mililitiro 10 kugeza kuri 15 za GBL cyangwa 1,4-BD kumunsi ** (abakoresha 24/7 bakunze kurya 30 to 80+ mL ya GBL buri munsi).

2. Isaha-ku-isaha Igihe cyo gukuramo GHB / GBL¶

Kuberako plasma igice cyubuzima bwa GHB kiri munsi yiminota 60, gukuramo bitangira ** mbere yuko umuntu ava mubyumba byihutirwa cyangwa indege **:

3. Impamvu gukuramo GHB ari "Benzodiazepine-Irwanya" (Kandi Kuki Baclofen arokora ubuzima)¶

Iyo umurwayi wikuramo inzoga ageze mubitaro, imitsi ** diazepam cyangwa lorazepam ** itera ** $ inyandiko {GABA} _A $ chloride umuyoboro **, igasimbuza ingaruka zo kubuza inzoga. Ibinyuranye, GHB, GBL, na 1,4-butanediol ikora cyane cyane kuri metabotropic ** $ inyandiko {GABA} _B $ yakira ** na ** GHB yakira **, hamwe nibikorwa bidakwiriye ku $ inyandiko {GABA} _A $ yakira ku kigero gisanzwe. Mubakoresha karande 24/7, $ inyandiko {GABA} _B $ reseptors iragabanijwe cyane; iyo GHB ihagaze, glutamate ya presynaptic na dopamine neuron irashya bidasubirwaho kuko feri yabo ** $ inyandiko {GABA} _B $ feri yabuze **.

Gutanga ibipimo bisanzwe bya benzodiazepine (itera gusa $ inyandiko {GABA} _A $ reseptors) akenshi binanirwa guhagarika iyi caskade: ** abarwayi bafite gukuramo GHB bikabije basabye miligarama 200 kugeza 500+ za diazepam yinjirira mumasaha 24 ** kandi baracyafite ikibazo cya delirium keretse niba ** ** inyandiko {GAcl} _B $ ** phenobarbital / propofol ** yongeyeho.

4. Imbonerahamwe yo kugereranya: Kunywa inzoga na Benzodiazepine Gukuramo na GHB / GBL Gukuramo¶

Igice cya 4: Kwangiza-Kugabanya Pipette Kunywa & Kurinda Kurenza Impanuka¶

Hafi ya 100 ku ijana byica cyane GHB / GBL bituruka ku makosa ane ashobora gukumirwa: gupimwa agapira k'icupa aho kuba siringi yagaragajwe, kuvanga n'inzoga cyangwa imiti igabanya ubukana, kongera kunywa mbere yuko ikinini kibanziriza, cyangwa kunywa ku icupa ry'amazi ridashyizweho ikimenyetso.

+-------------------------------------------------------------------------+
|       THE 4 LIFE-SAVING GHB / GBL HARM-REDUCTION RULES                  |
|                                                                         |
|  1. MEASURE EVERY DOSE TO 0.1 mL WITH A 1 mL ORAL BARREL SYRINGE:       |
|     NEVER pour into a bottle cap or cup. A standard water-bottle cap    |
|     holds 5 to 7 mL (up to 3x a lethal coma dose of GBL).               |
|                                                                         |
|  2. DYE AND LABEL EVERY CONTAINER IMMEDIATELY:                          |
|     NEVER store GHB, GBL, or 1,4-BD in a clear drinking water bottle.   |
|     Add blue food coloring and wrap a warning label around the bottle.  |
|                                                                         |
|  3. SET A STRICT 2.5 TO 3 HOUR TIMER ON YOUR PHONE BEFORE RE-DOSING:    |
|     Log your exact mL dose and timestamp on your phone screen. Never    |
|     take a booster dose inside 2 hours.                                 |
|                                                                         |
|  4. ZERO ALCOHOL, ZERO KETAMINE, ZERO BENZOS, ZERO OPIOIDS:             |
|     Even ONE beer or shot mixed with GHB/GBL multiplies respiratory     |
|     arrest risk, and alcohol + 1,4-BD creates a delayed liver bomb.     |
+-------------------------------------------------------------------------+

Impamvu utagomba na rimwe kugerageza urugo rutagenzuwe kuva 24/7 GBL Koresha¶

Iyo umuntu amenye ko yafatiwe mumubiri 24/7 GHB / GBL (kubyuka buri minota 90 kugeza 120 kugirango yipime), kugerageza kureka inkoko ikonje murugo cyangwa kwivuza akabari kumuhanda "Xanax" cyangwa inzoga byangiza ubuzima:

• ** Impamvu Ubukonje bwa Turukiya bwananiwe: ** Mu masaha 3 kugeza kuri 6 yo guhagarara, guhinda umushyitsi, kuruka, no kwitiranya ibintu; ku isaha 12 kugeza 24, acute paranoid delirium ikuraho ubushobozi bwo guhamagara ambulance.
• ** Impamvu Inzoga cyangwa Umuhanda Benzodiazepines Yica: ** Kunywa inzoga hejuru ya GHB / 1,4-BD isigaye cyangwa gufata alprazolam yo mumuhanda wiganano (bikunze gushyirwaho na ** fentanyl cyangwa bromazolam **) itera ifatwa ryubuhumekero udahagarika $ inyandiko {GABA} _B $ gukuramo delirium.

• ** Ikiraro cyizewe kugeza igihe cyo kwinjira mu bitaro: ** Amabwiriza y’imiti y’ibiyobyabwenge (** UK NEPTUNE n’Ubuholandi NISPA **) agira inama ** kudahagarika imiti yo kubungabunga mu buryo butunguranye mu rugo ijoro ryabanjirije kwinjira **. Genda uhite ujya mu ishami ryihutirwa cyangwa ikigo cyita ku barwayi ** mbere yo gukuramo delirium itangira **, uzane ibiti byawe hamwe nuducupa kugirango abaganga bashobore gutangiza ** umurwayi wa Baclofen + Diazepam inzibacyuho igenzurwa ** munsi yumutima na Creatine Kinase (CK) gukurikirana.

• (Niba wowe cyangwa umuntu ukunda urwana na GHB, GBL, cyangwa polysubstance, reba Gukoresha ibiyobyabwenge nibiyobyabwenge: ubuyobozi bwihutirwa na Gufasha umwe mu bagize umuryango wabaswe. Umuntu wese witabira ibirori byubuzima bwa nijoro cyangwa ashyigikira umuntu uri mukaga agomba kurangiza ubufasha bwambere bwemewe nubufasha bwibanze bwubuzima binyuze muri Croix-Rouge, Ambulance ya St John, cyangwa utanga amahugurwa yaho.) *

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

Mugihe uhamagaye ikigo cyita kuri ambulance cyangwa uburozi mugihe cya GHB, GBL, cyangwa 1,4-butanediol, vuga neza niba umurwayi ari muri koma ikaze idasanzwe ("G-hole" / depression de respiratory) ** cyangwa ** acute 24/7 gukuramo delirium **.

Ibibazo bikunze kubazwa¶

Kuyobora¶

• Kunywa inzoga, delirium ihinda umushyitsi, gufatwa, hamwe na triox trix
• Gukuramo Benzodiazepine ibyago byo gufatwa no gufata ibyuma byihutirwa
• Kurenza urugero ('overamping'): hyperthermia, kubabara mu gatuza, hamwe na triage
• Gusubiramo no kurenza urugero: kwirinda ibizamini bya fentanyl / xylazine na naloxone
• Gukoresha ibiyobyabwenge nibiyobyabwenge: ubuyobozi bwihutirwa
• Inomero zihutirwa

Inkomoko nubuyobozi¶

• ** Ikigo cy’ubumwe bw’ibihugu by’i Burayi (EUDA / cyahoze cyitwa EMCDDA) & Ikigo cy’ubuvuzi cya kaminuza ya Radboud Nijmegen (NISPA, Ubuholandi): ** * GHB, GBL na 1,4-BD: Pharmacokinetics, Imiti ikabije y’ibiyobyabwenge, hamwe na Porotokole yangiza hakoreshejwe imiti ya GHB na Baclofen *.
• ** Ubuvuzi bushya bwo kuvura indwara zo mu Bwongereza (NEPTUNE) & Serivisi ishinzwe amakuru y’uburozi bw’Ubwongereza (TOXBASE): ** * Amabwiriza ku micungire y’amavuriro y’imiti ikaze kandi idakira y’ibiyobyabwenge bya Club hamwe n’ibintu byangiza umubiri: GHB na GBL *.
• ** Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS) Komite ishinzwe impuguke zishingiye ku biyobyabwenge (ECDD): ** * Raporo y'isuzuma ryibanze kuri Acide ya Gamma-Hydroxybutyric (GHB), Gamma-Butyrolactone (GBL), na 1,4-Butanediol (1,4-BD) *.
• ** Sosiyete y'Abanyamerika ishinzwe ubuvuzi bw’ibiyobyabwenge (ASAM) & Ishuri Rikuru ry’Ubuvuzi ry’Abanyamerika (ACMT): ** * Amabwiriza y’ubuvuzi ku bijyanye no gucunga imiti igabanya ubukana, Hypnotic, cyangwa Anxiolytic (harimo GHB / GBL Benzodiazepine-Kurwanya Gukuramo Delirium, Baclofen Adjunctive Therapy
• ** Kunywa Ibiyobyabwenge hamwe n’ubuyobozi bushinzwe ubuzima bwo mu mutwe (SAMHSA) & Ikigo cy’igihugu gishinzwe kurwanya ibiyobyabwenge (NIDA / NIH, Amerika): **