[Acute gamma-butyrolactone poisoning with withdrawal syndrome]. / Ostre zatrucie gamma-butyrolaktonem z zespolem abstynencyjnym.

Gamma-butyrolactone (GBL) is a solvent that are part of many consumer products and in most countries can be legally purchased in the form of almost pure substance. After ingestion GBL is rapidly converted to gamma-hydroxybutyric acid (GHB). In recent years, GBL became a legal alternative to GHB, which is used widely since 1990s as a club drug and date rape drug. It is believed that abuse of GBL is not frequent in Europe, except for certain specific groups, mainly in urban centers in the west of the continent. We present a case of acute GBL poisoning with the withdrawal syndrome in 23-year-old man living in a rural area in eastern Poland. The patient was admitted to the Intensive Care Unit (ICU) because of coma of unknown origin. On admission erosions of the lips and mouth was seen. Ethyl alcohol was not present in blood sample, urine screening tests for drugs were negative. During his stay in the ICU patient required ventilatory support, was periodically agitated with muscular jerks and opisthotonos. The later medical history revealed that the patient from two years used GBL, which purchased as wheels cleaner. The tolerance developed, and the interruption of use of substance triggered symptoms of withdrawal. GBL abuse occurs in different social groups and is at risk for acute toxicity and the development of physical dependence.

[Two cases of rhabdomyolysis with a different clinical course]. / Dwa przypadki rabdomiolizy o róznym przebiegu klinicznvm.

Rhabdomyolysis is a syndrome provoked by the injury to skeletal muscles and the release of muscle cell contents into the plasma. The aetiology and clinical course are extremely variable. This is sometimes the reason of the diagnostic difficulties or even errors. Acute renal failure is the often and serious complication of rhabdomyolysis. The correct and early diagnosis of rhabdomyolysis is a key to successful treatment and prevention of the possible complications. Two cases of rhabdomyolysis with different aetiology and clinical course are presented in this paper. A 39-year-old man was admitted with the symptoms of dyspepsia. During the first day he developed the acute renal failure and later the acute respiratory failure. The initial serum creatine phosphokinase (CPK) activity was about 225,000 U/L. Haemodialysis, plasmapheresis and respiratory therapy were performed. A 25-year-old man was admitted with the swollen leg of the uncertain origin. His initial CPK activity was 18,993 U/L. The patient was treated with the infusions of fluids and sodium bicarbonate. He did not develop renal failure. Despite of the initial diagnostic doubts, in both cases the outcome was excellent.