Gamma-Hydroxybutyrate Toxicity Clinical Presentation

Updated: Dec 29, 2015
  • Author: Theodore I Benzer, MD, PhD; Chief Editor: Asim Tarabar, MD  more...
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Presentation

History

Patients with gamma-hydroxybutyric acid (GHB) toxicity typically present with altered mental status, making it difficult or impossible to obtain reliable history. The history may include agitation and confusion as well as myoclonus and seizurelike activity. [7]

  • Prehospital personnel frequently have valuable information from the scene implicating GHB as the cause of the patient's complaint.
  • History may also be obtained from bystanders or friends since patients frequently ingest GHB in the presence of others at the gym, nightclubs, or parties.
  • History that the GHB was manufactured in a home lab is important since homemade GHB can be contaminated with sodium hydroxide (lye).
  • Patients given GHB surreptitiously as part of a drug-facilitated rape may have no history at all of drug ingestion.
  • Many patients present after taking multiple drugs, and efforts should be made to identify everything the patient has ingested.
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Physical

See the list below:

  • Neurologic findings: After GHB ingestion, the patient may have a period of euphoria that is rapidly followed by a period of profoundly depressed level of consciousness. This may progress to coma with a Glasgow Coma Scale of 3. GHB intoxication characteristically produces episodes of agitated delirium that can precede or follow the period of stupor or coma. Seizurelike movements and myoclonus are common during the course of the intoxication. These findings may reverse rapidly leaving the patient awake, alert, and oriented within minutes after several hours of altered mentation.
  • Cardiovascular findings: Bradycardia occurs in approximately 30-35% of ingestions. Hypotension occurs in approximately 10% of GHB ingestions and is usually mild. More profound cardiovascular changes can be seen in the presence of multidrug ingestions.
  • Pulmonary findings: Respiratory depression leading to frank apnea can occur and is exacerbated by multidrug ingestions. Decreased breath sounds or rales may indicate aspiration of gastric contents. Pulmonary edema is not a finding that is usually associated with GHB.
  • Gastrointestinal findings: Nausea and vomiting are common in GHB ingestions, especially during reemergence. Alkali burns to the lips, mouth, and GI tract can be seen when the GHB is contaminated by sodium hydroxide during the manufacturing process.
  • Constitutional: Mild hypothermia is a common finding in these cases.
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Causes

GHB is a common ingestion because it is easily manufactured and has several active precursors that have been available over the Internet. Its effects appeal to a variety of users.

  • Its euphoric effects make it a popular party drug.
  • Its reputation to increase growth hormone levels and muscle mass makes it popular with body builders.
  • Its rapid onset of action and formulation as a clear liquid make it popular in drug-facilitated rape.
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