GHB-Induced Delirium: A Case Report and Review of the Literature on Gamma Hydroxybutyric Acid

Hernandez, Mike; McDaniel, Charles H.; Costanza, C Della; Hernandez, Oscar

doi:10.3109/00952999809001706

Cited by 57 publications

(38 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[25][26][27] In cases where the same patient presented with multiple episodes of withdrawal, each episode was considered separately. Twenty-seven articles, all case series or case reports, fulfilled study eligibility criteria, [5][6][7][8][9][10][11][12][13][14][15][16][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] describing 57 patients with withdrawal: GHB in 36 cases, 1,4-BD in 3 cases and GBL in 18 cases. Mean age was 31 years (range 18-57 yr) and 65% (37/57) were male.…”

Section: Resultsmentioning

confidence: 99%

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Wojtowicz

Yarema

Wax

2008

CJEM

View full text Add to dashboard Cite

1,4-Butanediol (1,4-BD) is an industrial solvent that is metabolized to gamma-hydroxybutyrate (GHB), a gamma-aminobutyric acid agonist and central nervous system depressant. GHB and its analogues are popular drugs of abuse. Withdrawal from these agents is characterized by autonomic instability and altered mental status. We report a case of withdrawal from 1,4-BD lasting 6 days and complicated by new onset of seizures and rhabdomyolysis. In addition, we conducted a systematic review of the English literature pertaining to withdrawal from GHB, 1,4-BD and gamma-butyrolactone (GBL). Data collected from source articles included last use prior to symptom onset, clinical features on presentation, duration of symptoms and outcome. Twenty-seven studies with 57 episodes of withdrawal were included. Thirty-six cases (63%) involved GHB, 3 cases (5%) involved 1,4-BD and 18 (32%) involved GBL. The most common patient symptoms were tremor (67%), hallucinations (63%), tachycardia (63%) and insomnia (58%). Seizures and rhabdomyolysis each occurred in 7% of cases, but only 1 death occurred. Emergency physicians must consider withdrawal from these agents when patients present with clinical features suggestive of a sedative-hypnotic withdrawal syndrome. RÉSUMÉLe butane-1,4-diol (BD-1,4) est un solvant industriel qui se métabolise en 4-hydroxybutanoate (GHB), un agoniste de l'acide 4-aminobutanoïque et un dépresseur du système nerveux central. Le GHB et ses analogues sont des drogues populaires faisant l'objet d'abus. Le sevrage de ces agents se manifeste par une instabilité autonome et un état mental altéré. Nous présentons un cas de sevrage de BD-1,4 ayant duré 6 jours et ayant été compliqué par une nouvelle apparition de convulsions et de rhabdomyolyse. Nous avons en outre réalisé une revue systématique de la littéra-ture anglaise portant sur le sevrage du GHB, du BD-1,4 et du gamma-butyrolactone (GBL). Les données recueillies des articles sources incluaient des renseignements sur la dernière utilisation avant la survenue de symptômes, les manifestations cliniques à l'arrivée des patients à l'urgence, la durée des symptômes et les résultats. La revue portait sur 27 études décrivant 57 épisodes de sevrage. Trente-six cas (63 %) étaient liés au GHB, 3 cas (5 %) au BD-1,4 et 18 (32 %) au GBL. Les tremblements (67 %), les hallucinations (63 %), la tachycardie (63 %) et l'insomnie (58 %) étaient les symptômes les plus courants observés chez les patients. Les convulsions et la rhabdomyolyse se sont manifestées respectivement dans 7 % des cas, mais seulement 1 décès a eu lieu. Lorsqu'un patient présente des manifestations cliniques évoquant le syndrome de sevrage de sédatifs hypnotiques, les médecins d'urgence devraient considérer la possibilité de sevrage de ces agents.

show abstract

Section: Resultsmentioning

confidence: 99%

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Wojtowicz

Yarema

Wax

2008

CJEM

View full text Add to dashboard Cite

show abstract

“…GHB is used for treatment of narcolepsy, sleeping disorders, alcohol/opioid withdrawal, and as general anastethic adjunct. As an anesthetic, it never gained widespread acceptance but it is increasingly abused (Hernandez et al, 1998). Cell Culture.…”

mentioning

confidence: 99%

Transport of Pharmacologically Active Proline Derivatives by the Human Proton-Coupled Amino Acid Transporter hPAT1

Metzner

Kalbitz²,

Brandsch³

2004

J Pharmacol Exp Ther

View full text Add to dashboard Cite

Several proline derivatives such as L-azetidine-2-carboxylic acid, cis-4-hydroxy-L-proline, and 3,4-dehydro-DL-proline prevent procollagen from folding into a stable triple-helical conformation, thereby reducing excessive deposition of collagen in fibrotic processes and the growth of tumors. This study was performed to investigate whether the recently discovered human proton-coupled amino acid transporter 1 (hPAT1) is capable of transporting such pharmacologically relevant proline derivatives and also GABA analogs. Uptake of L- 3 H]proline uptake and flux inhibition. We conclude that 1) the substrate specificity of hPAT1 is very much broader than so far reported and 2) the system accepts therapeutically relevant proline and GABA derivatives. hPAT1 is a promising candidate for new ways of oral drug delivery.

show abstract

“…[110]. Un syndrome confusionnel, un delirium [111] et une rhabdomyolyse sont des complications de sevrage [112,113]. L'intensité et la sévérité du syndrome de sevrage sont soumises à des variations interindividuelles [114].…”

Section: Abus Et Dépendanceunclassified

Acide gamma-hydroxy-butyrique (GHB) : plus qu’un agent de soumission chimique, une véritable source d’addiction

et al. 2009

View full text Add to dashboard Cite

GHB-Induced Delirium: A Case Report and Review of the Literature on Gamma Hydroxybutyric Acid

Cited by 57 publications

References 6 publications

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Transport of Pharmacologically Active Proline Derivatives by the Human Proton-Coupled Amino Acid Transporter hPAT1

Acide gamma-hydroxy-butyrique (GHB) : plus qu’un agent de soumission chimique, une véritable source d’addiction

Contact Info

Product

Resources

About