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

• Published in: Drug and alcohol dependence 2006-02, Vol.81 (3), p.323-326
• Main Authors: Liechti, Matthias E., Kunz, Isabelle, Greminger, Peter, Speich, Rudolf, Kupferschmidt, Hugo
• Format: Article
• Language: English
• Subjects: 4-Butyrolactone - adverse effects; 4-Butyrolactone - toxicity; Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; Alcoholism; Alcoholism - epidemiology; Alcoholism and acute alcohol poisoning; Anesthetics, Intravenous - toxicity; Biological and medical sciences; Bradycardia - chemically induced; Bradycardia - epidemiology; Case-Control Studies; Coma; Coma - chemically induced; Coma - epidemiology; Drug abuse; Drug addiction; Drug Overdose; Female; Gamma-butyrolactone; Gamma-hydroxybutyrate; GBL; GHB; Humans; Hypothermia - chemically induced; Hypothermia - epidemiology; Intoxication; Liquid ecstasy; Male; Medical sciences; Multiple drugs; Opioid-Related Disorders - epidemiology; Overdose; Overdoses; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Sodium Oxybate - toxicity; Solvents - adverse effects; Solvents - toxicity; Toxicology
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2005.07.010

To describe the clinical features of gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) toxicity. Retrospective case-study of 65 GHB and GBL intoxications seen in an urban emergency department. 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%). 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.