Acute sodium oxybate intoxication: a case report and review of the literature.

Abstract

Despite a better safety profile than illicit γ-hydroxybutyric acid (GHB) and other GHB-analogs, sodium oxybate continues to raise serious concerns regarding clinical safety. In this study, the authors report the case of near-fatal intoxication involving sodium oxybate-alcohol combination in a 40-year-old woman. In addition, a review of the literature on published cases of intoxication involving this pharmaceutical form of GHB was conducted. A 40-year-old woman was admitted to the intensive care unit in a coma following voluntary ingestion of 18 g of sodium oxybate and alcohol. The GHB plasma concentration was quantified to be 146 mg/L using liquid chromatography coupled with tandem mass spectrometry. An English literature search was performed using PubMed without any limiting period to identify all available scientific publications involving cases of sodium oxybate intoxication; six cases were identified. Five cases involved fatal intoxication, with GHB post-mortem blood concentrations ranging from 11.5 to 3500 mg/L. One involved a non-fatal intoxication case with a GHB serum concentration of 569 mg/L 7 h post-ingestion. In the present case, the estimated elimination half-life was 154 min. The risk of acute poisoning appears to be high considering the pharmacokinetic properties of sodium oxybate. Physicians and toxicologists must take such properties into account.