Gamma Hydroxybutyric Acid (GHB) Intoxication

Abstract

Gamma hydroxybutyric acid (GHB) is a naturally occurring analog of gamma-aminobutyric acid (GABA) that has been used in research and clinical medicine for many years. In the past decade it has become very popular as a dietary supplement and recreational drug. Acute overdose leads to profound alteration of mental status and variable amounts of respiratory depression. With proper management, most patients recover fully within six hours. However, respiratory arrest and death have been reported in severe GHB intoxication. In addition to acute overdose, there is a GHB withdrawal syndrome that is similar to sedative/hypnotic and ethanol withdrawal. Recently several congeners of GHB, gamma butyrolactone and 1,4-butanediol, have emerged as drugs of abuse and show toxidromes similar to GHB. Emergency physicians should be familiar with the presentation and management of GHB-related emergencies.

Trends in gamma‐hydroxybutyrate‐related harms based on ambulance attendances from 2012 to 2018 in Victoria, Australia

“…The data presented here are derived from a database of all state-wide ambulance attendances related to alcohol and other drugs and/or mental health and therefore present a representative picture of pre-hospital harms. Importantly, acute presentations of methamphetamine with GHB are characterized by a picture of psychiatric (anxiety, psychosis) symptoms, markedly different from the pattern observed in people using GHB alone or in conjunction with alcohol, where sedation and lowered conscious state are the presenting risk [15]. This has clinical implications for paramedics who are responding to calls to attend to a GHB overdose, and for acute management of these patients within emergency department settings.…”

“…Because our statistical tests did not take into account any time component, and the estimated percentage of missingness was less than 2.8% without any expected distorting effect on the pattern of variables of interest, there was no statistical compensation for missing data. Statistical analysis was conducted in Stata/MP version 15…”

“…The trend of GHB and methamphetamine coconsumption may be driven by a number of factors. Pharmacologically, GHB is a CNS depressant [15] and use can result in respiratory depression and lowered conscious state [15]. Individuals using GHB may seek to prolong periods of euphoria by countering sedation with stimulants such as methamphetamine [6].…”

γ‐Hydroxybutyrate (GHB) in Humans

“…After GHB ingestion, a mild intoxication may be observed with nausea, dizziness, and difficulty in focusing the eyes. 10 Acute severe intoxications have been reported, where individuals may experience vomiting, extreme dizziness, disorientation, amnesia, and unconsciousness [4][5][6]11 that may evolve to convulsions, deep coma, and rarely death. 12 The range between high recreational doses and overdose is narrow; and acute intoxications are quite common in humans.…”

Survival of massive γ‐hydroxybutyrate/ 1,4‐butanediol overdose

“…5,6 GHB produces a syndrome of brief euphoria, relaxation, aggression, vomiting, incontinence, hypothermia, bradycardia, hypotonia, labile conscious level, myoclonus, seizure-like activity, respiratory depression, apnoea and death. 7 Spontaneous recovery usually occurs within 2-6 h 6-8 and sedation beyond this period suggests an alternative diagnosis.…”