A Case of γ-Butyrolactone Associated with Severe Withdrawal Delirium and Acute Renal Failure

Bhattacharya, Indrani; Watson, Fiona; Bruce, Malcolm

doi:10.1159/000324343

Cited by 9 publications

(10 citation statements)

References 28 publications

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“…The literature describes the occurrence of serious, life-threatening complications of delirium caused by GBL addiction. The authors reported among other things, respiratory failure and acute renal failure [4,10,11]. In the management of withdrawal syndromes and delirium in GBLaddicted patients using of benzodiazepines is recommended [1,2,4,5,6,7,9].…”

Section: Discussionmentioning

confidence: 99%

Delirium in the course of dependence upon gamma-butyrolactone (GBL) - a case report

Łobejko

Machała

Makarewicz

et al. 2016

Current Problems of Psychiatry

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Gamma-butyrolactone (GBL) is an organic chemical compound of the lactones group, undergoing biotransformation into gamma-hydroxybutyrate after the intake (GHB). Because of the easy access, low price and fast psychotropic effect, GBL is becoming increasingly popular substance having intoxicating effect. Taking of GBL causes dose-dependent euphoric, sedative, hypnotic effects. Its use can quickly lead to physical dependence with severe course of withdrawal syndromes. Withdrawal symptoms resemble those occurring in the course of addiction to alcohol or benzodiazepines. In some patients, delirium develops during substance withdrawal. There are described severe, life-threatening complications in the course of delirium in GBL-dependent patients. The management of withdrawal syndromes and delirium mainly involves administration of benzodiazepines. In this paper, we present a case of delirium in 24-year-old man addicted to GBL hospitalized in a psychiatric ward. Delirium in this patient went without complications and was successfully managed with diazepam and lorazepam.

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Section: Discussionmentioning

confidence: 99%

Delirium in the course of dependence upon gamma-butyrolactone (GBL) - a case report

Łobejko

Machała

Makarewicz

et al. 2016

Current Problems of Psychiatry

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“…Istnieją również pojedyńcze doniesienia o ostrej niewydolności nerek wymagającej dializy u pacjenta po przyjęciu gamma-butyrolaktonu (GBL) [34].…”

Section: Chemseks Jako Potencjalne Zagrożenie Dla Nerekunclassified

Different risk factors for chronic kidney disease in HIV-infected patients

Marchewka¹,

Domagała²,

Knysz³

et al. 2018

Farm Pol.

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Tom 74 • nr 3 • 2018 new nephrotoxic substances used during chemsex and co-morbidities influencing nephropathy in HIV positive individuals were analysed. Viral pathogens associated with kidney diseases such as CMV, EBV, VZV, adenoviruses and HBV or HCV were presented. Multiplicity and diversity of presented factors indicate how important is the problem of CKD in HIV positive patients. Awareness and analysis of these factors, systematic monitoring of the kidney function allows to adapt and modify therapy carried by clinicians.

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“…psychosis and aggression. A prolonged withdrawal state has been reported, lasting up to 3 weeks in several cases [77,138,147,148] and in some patients for 4 weeks to months [134], a state which is characterized by disorientation, depression, anxiety, panic attacks and insomnia [77,134]. The intensity of the withdrawal symptoms can urge abusers to maintain their illicit GHB levels by redosing frequently and around the clock [21], sometimes risking the danger of overdose and intoxication.…”

Section: Clinical Implication On Withdrawal Treatment and Relapsementioning

confidence: 99%

The Neurobiological Mechanisms of Gamma-Hydroxybutyrate Dependence and Withdrawal and Their Clinical Relevance: A Review

Kamal

Noorden²,

Franzek³

et al. 2016

Neuropsychobiology

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Objective: γ-Hydroxybutyrate (GHB) has gained popularity as a drug of abuse. In the Netherlands the number of patients in treatment for GHB dependence has increased sharply. Clinical presentation of GHB withdrawal can be life threatening. We aim, through this overview, to explore the neurobiological pathways causing GHB dependency and withdrawal, and their implications for treatment choices. Methods: In this work we review the literature discussing the findings from animal models to clinical studies focused on the neurobiological pathways of endogenous but mainly exogenous GHB. Results: Chronic abuse of GHB exerts multifarious neurotransmitter and neuromodulator effects on γ-aminobutyric acid (GABA), glutamate, dopamine, serotonin, norepinephrine and cholinergic systems. Moreover, important effects on neurosteroidogenesis and oxytocin release are wielded. GHB acts mainly via a bidirectional effect on GABA_B receptors (GABA_BR; subunits GABA_B1 and GABA_B2), depending on the subunit of the GIRK (G-protein-dependent ion inwardly rectifying potassium) channel involved, and an indirect effect of the cortical and limbic inputs outside the nucleus accumbens. GHB also activates a specific GHB receptor and β₁-subunits of α₄-GABA_AR. Reversing this complex interaction of neurobiological mechanisms by the abrupt cessation of GHB use results in a withdrawal syndrome with a diversity of symptoms of different intensity, depending on the pattern of GHB abuse. Conclusion: The GHB withdrawal symptoms cannot be related to a single mechanism or neurological pathway, which implies that different medication combinations are needed for treatment. A single drug class, such as benzodiazepines, gabapentin or antipsychotics, is unlikely to be sufficient to avoid life-threatening complications. Detoxification by means of titration and tapering of pharmaceutical GHB can be considered as a promising treatment that could make polypharmacy redundant.

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A Case of γ-Butyrolactone Associated with Severe Withdrawal Delirium and Acute Renal Failure

Cited by 9 publications

References 28 publications

Delirium in the course of dependence upon gamma-butyrolactone (GBL) - a case report

Delirium in the course of dependence upon gamma-butyrolactone (GBL) - a case report

Different risk factors for chronic kidney disease in HIV-infected patients

The Neurobiological Mechanisms of Gamma-Hydroxybutyrate Dependence and Withdrawal and Their Clinical Relevance: A Review

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