• Eva-Carina Heier, Florian Eyer, Christian Rabe, Stefanie Geith, Paul I Dargan, David M Wood, Fridtjof Heyerdahl, Alison M Dines, Isabelle Giraudon, Erik HovdaKnutKThe Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway., Chris Yates, Odd Martin Vallersnes, Òscar Miró, Matthias E Liechti, Tobias Zellner, and Euro-DEN Research Group.
• Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, TUM School of Medicine, Technical University of Munich, Germany.
• Eur J Emerg Med. 2022 Aug 1; 29 (4): 291-300.

Background And ImportancePatients 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.ObjectiveTo 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 ParticipantsA retrospective multicentre study using data from the Euro-DEN Plus database from January 2014 to December 2019.Outcomes Measure And AnalysisComparison of epidemiologic and clinical characteristics, ED and hospital management of patients with CNS depressant intoxication with or without ethanol co-use.Main ResultsAlthough 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).ConclusionCo-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.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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