Läkartidningen
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Review Case Reports
[GHB--dangerous, addictive and uncontrollable "party drug"].
This report reviews the pharmacology, toxicity and abuse pattern of gamma-hydroxybutyrate (GHB). The legislative changes pertaining to this substance are also addressed. ⋯ It is concluded that GHB is widely abused, particularly among the younger generation, and that further cases of severe intoxication are likely to occur as long as the substance is easily available from countless sources, including via the Internet. Despite the classification of GHB as a narcotic in Sweden and several other countries, continued problems are expected since the precursors gamma-butyrolactone (GBL) and 1,4-butanediol (BD) are widely--and legally--available.
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Different symptoms and clinical signs of metabolic disease in the neonatal period are reviewed. Initial laboratory studies dealing with critically ill neonates are recommended. Different biochemical findings are commented and linked towards the most probable diseases. Finally, treatment in the acute phase of disease is presented.
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In about 10 per cent of children with cerebral palsy, the most probable cause is birth asphyxia. The brain injury following birth asphyxia evolves in part over hours or days--as a secondary process. This opens a 'window of opportunity' for intervention. ⋯ Pilot trials of cooling suggest that the side-effects of cooling can be managed. Randomized controlled trials are underway. Obtaining informed consent from the parents for these trials represents a particular challenge.
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General anesthesia induces hypothermia due to decreased metabolic rate and impaired thermoregulation. Adverse effects of hypothermia are common. Many warming devices are in use to prevent heat loss, but little attention has been paid to stimulating the body's own heat generation. ⋯ During anesthesia the thermogenic effect of i.v. amino acids was increased. The results support the existence of an inhibitory action normally exerted by central thermosensors in order to prevent hyperthermia. During anesthesia, central thermosensors are impaired, and hence amino acid thermogenesis is exaggerated, which may prevent hypothermia.
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The neonate has a functional nociceptive system. However, recent research suggests that infants may be more vulnerable to the negative effects of pain than older children and adults. Apart from short-term effects, untreated pain may also have long-term effects, which may later affect neurological development, including the reaction to pain. Despite convincing evidence from recent research, the neonate is still subjected to painful procedures, even surgery, without adequate treatment.