Gamma-hydroxybutyrate Overdose Research Articles

Effect of intubation for gamma-hydroxybutyric acid overdose on emergency department length of stay and hospital admission.

The objective was to examine the effect of endotracheal intubation on emergency department (ED) length of stay (LOS) and admission rates for patients with gamma-hydroxybutyrate (GHB) overdose. A 3-year retrospective electronic and paper audit of recreational drug presentations was carried out at two major inner-city EDs in Melbourne, Australia. Different GHB overdose management strategies exist at the respective audit sites, namely: 1) all patients with a Glasgow Coma Scale (GCS) score of 8 or less are intubated or 2) uncomplicated patients with GCS scores of 8 or less are managed without intubation (conservative management), unless further complications arise. This difference allows for comparison of the effects of intubation. All suspected GHB-related cases (defined as cases where GHB or its analogs gamma-butyrolactone or 1,4-butanediol were recorded) in which altered consciousness state was noted as a presenting symptom at triage were selected from all recreational drug-related presentations occurring between January 2008 and December 2010. The relationship between intubation and the primary outcome, ED LOS, was examined using robust regression after adjustment for potential confounders. The relationship between intubation and admission status (admission to hospital versus discharge) was also examined using logistic regression. After adjustment for potential confounders such as GCS score, intubation of GHB-related cases in the ED was associated with an increase in mean LOS of 41% (95% confidence interval [CI] = 19% to 65%) and an increase in the odds of admission to hospital of 9.95 (95% CI = 2.36 to 41.88) at one hospital site, compared to conservative airway management. Conservative airway management (no intubation) is associated with shorter ED LOS in cases of uncomplicated GHB-related coma in the ED and may also be associated with lower admission rates for these patients.

Temporal differences in gamma-hydroxybutyrate overdoses involving injecting drug users versus recreational drug users in Helsinki: a retrospective study

BackgroundGamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) have been profiled as 'party drugs' used mainly at dance parties and in nightclubs on weekend nights. The purpose of this study was to examine the frequency of injecting drug use among GHB/GBL overdose patients and whether there are temporal differences in the occurrence of GHB/GBL overdoses of injecting drug and recreational drug users.MethodsIn this retrospective study, the ambulance and hospital records of suspected GHB- and GBL overdose patients treated by the Helsinki Emergency Medical Service from January 1st 2006 to December 31st 2007 were reviewed. According to the temporal occurrence of the overdose, patients were divided in two groups. In group A, the overdose occurred on a Friday-Saturday or Saturday-Sunday night between 11 pm-6 am. Group B consisted of overdoses occurring on outside this time frame.ResultsGroup A consisted of 39 patient contacts and the remaining 61 patient contacts were in group B. There were statistically significant differences between the two groups in (group A vs. B, respectively): history of injecting drug abuse (33% vs. 59%, p = 0.012), reported polydrug and ethanol use (80% vs. 62%, p = 0.028), the location where the patients were encountered (private or public indoors or outdoors, 10%, 41%, 41% vs. 25%, 18%, 53%, p = 0.019) and how the knowledge of GHB/GBL use was obtained (reported by patient/bystanders or clinical suspicion, 72%, 28% vs. 85%, 10%, p = 0.023). Practically all (99%) patients were transported to emergency department after prehospital care.ConclusionThere appears to be at least two distinct groups of GHB/GBL users. Injecting drug users represent the majority of GHB/GBL overdose patients outside weekend nights.

Twenty‐three deaths with γ‐hydroxybutyrate overdose in western Sweden between 2000 and 2007

gamma-Hydroxybutyrate (GHB) is a drug of abuse with a status as being safe. In spite of a reputation of low toxicity, a huge number of deaths associated with this drug have been recorded during recent years in Sweden. It is unclear whether coingestion with other drugs or ethanol causes death in GHB overdoses or whether GHB itself is the main cause of death. The aim of this study was to analyze the cause of death in GHB-related fatalities seen in our region. All cases of deaths with GHB during the year 2000-2007 in the region of western Sweden were studied retrospectively. The cases were classified as either GHB poisonings without any, with a minor or a major influence of other drugs on the cause of death. Twenty-three cases were diagnosed as deaths due to GHB overdose. Ninety-one percent coingested other substances. Ninety-one percent of the decedents were male. Age varied between 16 and 46, with the median age at 25 years. Forty-three percent of the cases were classified as GHB poisonings without any or a minor influence of other drugs on the cause of death. Thirty percent also ingested ethanol. Two patients (9%) were only intoxicated with GHB. Intoxication with GHB carries some mortality. Combining GHB with ethanol does not explain the many deaths in our region, nor do extremely high plasma concentrations of GHB. The intake of opioids increases the toxicity of GHB. The drug itself has such biological activities that an overdose is dangerous and may lead to death.

Effects of L-Lactate and D-Mannitol on γ-Hydroxybutyrate Toxicokinetics and Toxicodynamics in Rats

Overdoses of gamma-hydroxybutyrate (GHB), a drug of abuse, result in coma, respiratory arrest, and death. The objective of this study was to evaluate a potential GHB detoxification strategy by inhibiting the monocarboxylate transporter (MCT)-mediated renal reabsorption of GHB in rats, using the MCT substrate L-lactate. The use of the osmotic diuretic D-mannitol alone or combined with L-lactate was also explored. GHB (208 mg/h/kg) was infused i.v. for 3 h in the absence or presence of L-lactate (60.5, 121, and 302.5 mg h(-1) kg(-1)), D-mannitol (0.5 g/kg), or L-lactate (60.5 mg h(-1) kg(-1)) combined with D-mannitol (0.5 g/kg). GHB in plasma and urine samples was determined along with blood pH, electrolytes, glucose, and L-lactate. Administration of L-lactate, or the combination of L-lactate and D-mannitol, but not D-mannitol alone, significantly increased the renal and total clearances of GHB in rats. Blood pH and electrolyte concentrations exhibited small changes with GHB, GHB/lactate, and GHB/mannitol treatments, although most values remained within their normal range. The concomitant administration of lactated Ringer's solution (28 mM L-lactate) at 300 mul/min with mannitol (0.5 g/kg) resulted in a significant increase in GHB clearance and a decrease in sleep time after an i.v. dose of 1 g/kg. Overall, our results indicated the following: 1) the use of the MCT inhibitor L-lactate can increase the renal and total clearances of GHB, and 2) the combination of lactated Ringer's solution and D-mannitol significantly alters GHB toxicokinetics and toxicodynamics and represents a potential clinical detoxification strategy for the treatment of GHB overdoses.

Paroxysmal sympathetic surge associated with gamma hydroxybutyrate

Gamma hydroxybutyrate is increasingly being used recreationally in the United Kingdom. We present a case of gamma hydroxybutyrate overdose associated with paroxysmal sympathetic storm, a phenomenon usually confined to patients who have sustained traumatic brain injury.

Clinical features of gamma-hydroxybutyrate and gamma-butyrolactone toxicity and concomitant drug and alcohol use

Objective To describe the clinical features of gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) toxicity. Methods Retrospective case-study of 65 GHB and GBL intoxications seen in an urban emergency department. Results 63% of intoxications occurred in male patients. The median age was 24 years (range 16–41 years). 65% co-ingested alcohol or illicit drugs, mostly MDMA and cocaine. 83% presented with coma. The mean ± S.D. time to regain consciousness among comatose patients was 111 ± 61 min and was significantly longer in patients who co-abused illicit drugs such as cocaine or MDMA (155 ± 60 min). Bradycardia occurred in 38%, hypotension in 6% and hypothermia in 48%. Agitation was observed in 17% of all patients and was significantly more frequent in patients with alcohol co-use (29%). Vomiting occurred in 31% of all patients and tended to be more frequent in patients who co-used alcohol (39%). Management of GHB and GBL overdose was supportive. Four patients needed admission to an intensive care unit for mechanical ventilation (6%). Conclusions Overdosing of GHB and GBL frequently results in non-reactive coma reflecting the severity of poisoning. Multiple drug use is common and significantly influences the clinical presentation.

Suspected GHB Overdoses in the Emergency Department

Blood specimens from 146 suspected gamma-hydroxybutyrate (GHB) overdose cases, presenting to an emergency department in Washington State over a 12-month period, were analyzed for GHB and other drugs. Of these 146 patients, GHB was confirmed in approximately one-third of the patients (N = 54), sometimes in potentially toxic concentrations. These patients were aged between 17 and 59 years (median 28 years), and 83% were male. Blood GHB concentrations ranged from 29 to 490 mg/L (mean 137 mg/L; median 103 mg/L). In 36 (67%) of the 54 patients, other drugs were additionally detected. Ethanol was measured in 22 (41%) patients, with concentrations ranging from 0.01 to 0.26 g/100 mL (median 0.04 g/100 mL). Other commonly co-administered drugs included 3,4-methylenedioxymethamphetamine, marijuana, methamphetamine, cocaine, and citalopram. Frequently observed clinical symptoms on admission for the GHB overdose group included copious vomiting, ataxia, lack of gag reflex, respiratory depression, mild acute respiratory acidosis, unconsciousness, and sudden altered states of consciousness. Many patients required intubation, and several became combative and required restraints. The majority of patients were discharged within 6 h of hospital admission. However, despite presenting with similar clinical symptoms on admission, GHB was not confirmed in 92 of the 146 overdose patients, suggesting that GHB overdose cases may frequently be indistinguishable from other drug overdoses or medical conditions.

The prevalence and correlates of gamma-hydroxybutyrate (GHB) overdose among Australian users.

The aim of this study was to examine the correlates, context and risk perceptions regarding gamma-hydroxybutyrate (GHB) overdose among a sample of recreational GHB users in Australia. A cross-sectional survey of 76 GHB users who were administered a structured interview on GHB use. They were asked a series of questions regarding whether they had ever experienced a GHB overdose, the context of their most recent GHB overdose, and about their perceptions of the risks of GHB overdose. This sample of GHB users had not had a long or extensive experience with GHB use; despite this, half (53%) had experienced a GHB overdose. This sample of GHB users appeared to be well-educated, employed and a history of either drug treatment or incarceration was uncommon. There were no differences between those who had or had not overdosed in terms of socio-demographic characteristics, extent of other drug use or typical patterns of other drug use when using GHB. However, those who had overdosed on GHB had used it more times during their life-time, and had been using it for a longer period of time. GHB-related overdoses were common among a sample of GHB users who had only recently begun using the drug. The only apparent distinguishing factor between those who had and had not overdosed on GHB was the amount of experience with GHB use.

POISONING WITH GAMMA-HYDROXYBUTYRATE, GAMMA-BUTYROLACTONE AND 1.4-BUTANDIOL

Background. Gamma-hydroxybutyrate (GHB) is a popular recreational drug. GHB overdose typically presents with decreased level of consciousness, miosis, bradycardia, respiratory depression and death. Typically, combativeness, confusion and vomiting occur once the patient begins to recover. Gamma-butyrolactone (GBL) and 1.4-butandiol (1.4-BD) are the prodrugs of GHB and have similar clinical presentation. We present the case of GHB poisoning in Ljubljana. Conclusions. Physicians should suspect GHB poisoning in young ravers who present with CNS depression. Treatment is symptomatic. There is no specific antidote. Gastric lavage is not beneficial but activated charcoal is recommended.

Gamma-hydroxybutyrate overdose and physostigmine: Teaching new tricks to an old drug?

Gamma-hydroxybutyrate was introduced as an anesthetic agent in the 1960s and is still used in some countries, despite recognized disadvantages. More recently, it has emerged as a popular recreational drug. We report 3 cases of gamma-hydroxybutyrate overdose, the effects of which were reversed by the administration of low-dose intravenous physostigmine. The origins of this regimen and the case for physostigmine as a potential antidote are described. [Caldicott DGE, Kuhn M. Gamma-hydroxybutyrate overdose and physostigmine: teaching new tricks to an old drug? Ann Emerg Med. January 2001;37:99-102.]

Gamma-hydroxybutyrate overdose and coma: a case report

Gamma-hydroxybutyrate overdose and coma: a case report

Acute Toxicity From Home-Brewed Gamma Hydroxybutyrate

Gamma hydroxybutyrate (GHB) has become an increasingly dangerous, illicitly marketed substance with numerous potential health hazards. 1-8 GHB was originally developed as an anesthetic but was withdrawn as a result of unwanted side effects.4 Marketed for the treatment of narcolepsy and alcohol withdrawal, it was used illicitly as a growth hormone and fat-burning drug by body builders. It has also been used as a date-rape drug.1,Z,9,10 In 1990 the Food and Drug Administration banned the sale of GHB in the United States. Common street names for gamma hydroxybutyrate include GHB, Liquid E, Liquid X, and Scoop. It is also referred to as gamma hydroxy, 4-hydroxybutyrate, gamma hydroxybutyrate sodium, and sodium oxybate. This drug, reported to stimulate growth hormone release, body building, and weight loss, as well as act as a sleeping potion,I-5 is also associated with a number of serious neurologic, cardiovascular, respiratory, and gastrointestinal side effects.IO-IS We describe a case of GHB abuse from a home-brewed preparation resulting in toxicity, withdrawal symptoms, and rhabdomyolysis. The withdrawal symptoms included insomnia, anxiety, and tremors, which resolved within 9 days.13,16 This case is the first reported describing GHB overdose associated with withdrawal symptoms and rhabdomyolysis. GHB became popular as a drug to help assault women. 1,2,IO Several properties of this drug account for its popularity as an tool in sexual assault. First, although no longer legally accessible, GHB is easily and cheaply manufactured in the home. Second, the drug is colorless, tasteless, and odorless, and it mixes well with all liquid and foods; as a result, it is easy for an unaware person to consume this drug. Third, shortly after consumption of

Gamma hydroxy butyrate overdose

AbstractA 17 year old girl who ingested possibly as little as 7ml of gamma hydroxy butyrate (GHB) presented to the emergency department deeply unconscious. Ambulance personnel had found her to be hypotensive with a bradycardia. Despite the fact that this drug may cause hypotension, seizures, bradyarrhythmias and coma, it is not a scheduled drug in this country.