sodium-oxybate and Drug-Overdose

Chemsex and slamsex represent a serious public health concern that has to be considered by both clinical and forensic toxicologists. Indeed, such practices appear to carry a significant degree of risk, including acute intoxication. Here we report the case of the intoxication of a 31-year-old male involving 3-methylmethcathinone (3-MMC) and gamma-hydroxybutyrate (GHB) during a slamsex session. In addition, we conducted a review of further cases. The 31-year-old man was admitted to the emergency department for severe impaired consciousness following the administration of psychoactive substances during a chemsex party. The detection and determination of 3-MMC and GHB concentrations were achieved using liquid chromatography-tandem mass spectrometry. 3-MMC and GHB blood concentrations were 177 ng/mL and 131 mg/L, respectively. Further, an English and French exhaustive literature search was performed using several different electronic databases without any limiting period in order to identify all published case reports detailing chemsex/slamsex-related (fatal and nonfatal) intoxications. Nine publications detailing chemsex/slamsex-related intoxication cases have been published (between 2016 and 2020). These articles reported an overall of 13 cases, all involving men with a mean age of 39.1±9.8 years. The outcome was fatal in only 6 cases. 4-MEC and GHB were the two predominant drugs identified. However, given the rapid emergence of novel NPSs in the global market as well as the ease with which they can be accessed through the Internet, toxicological laboratories have to be ready to face new patterns of intoxications resulting from chemsex/slamsex.

Topics: Adult; Chromatography, Liquid; Drug Overdose; Forensic Toxicology; Humans; Male; Methamphetamine; Psychotropic Drugs; Sexual Behavior; Sodium Oxybate; Substance Abuse Detection; Tandem Mass Spectrometry

γ-Hydroxybutyrate (GHB) is a common drug of abuse and poses important health risks to users in the form of respiratory, cardiovascular, mental, or traumatic adverse events. GHB has non-dose-proportional effects and pharmacologic effects such as sedation and retrograde amnesia, which can incapacitate people targeted for assault. It has Krebs cycle metabolism, rapid clearance, relative hydrophilicity, and unique drug interactions. Promptly seeking medical attention during intentional or inadvertent overdose is critical to survival, as is prompt supportive care once medical personnel are alerted. People drugged before assault also need to promptly notify authorities because the period to detect the drug in the urine or blood is brief and the ultimate metabolites are carbon dioxide and water. After acute treatment has passed, withdrawal could be severe in chronic abusers that could harm the patient directly or drive them back into reuse.

Topics: Anesthetics, Intravenous; Animals; Drug Overdose; Humans; Illicit Drugs; Rape; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

In several countries, including the Netherlands, the use of GHB seems to be rising. GHB is regarded by recreational users as an innocent drug without any side effects. Recently, the number of patients in treatment due to GHB addiction sharply increased. In addition, various studies report incidents following risky GHB use or GHB overdosing. Other sedative drugs, like ketamine and alcohol have been shown to result in unintended neurotoxic harm at the level of memory and cognitive function. As outlined in the present review, GHB and ketamine have a common mode of action, which suggests that GHB may also lead to similar neurotoxicity as ketamine. GHB overdosing, as well as binge drinking (and high ketamine doses), induce profound coma which is probably neurotoxic for the brain especially in the maturing brain of young adults. It is therefore advocated to investigate possible long-term neurotoxic effects in recreational GHB users e.g. by studying the residual effects on cognition and memory.

Topics: Alcoholism; Anesthetics; Anesthetics, Dissociative; Animals; Central Nervous System Depressants; Cognition Disorders; Coma; Drug Overdose; Ethanol; Glutamic Acid; Humans; Illicit Drugs; Ketamine; Neurotoxicity Syndromes; Oxidative Stress; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Succinate-Semialdehyde Dehydrogenase

Gammabutyrolactone is included in the solvent such as wheel cleaners, pesticides, cosmetics, drugs. After ingestion GBL is converted to gamma-hydroxybutyrate. Both substances are classified as so called "club drugs" and their action is characterized by euphoria, sedation, and induction of retrograde amnesia of events. These activities were basis for the use of GHB and its lactone as rape pill. Acute poisoning with these compounds causes confusion, agitation, ataxia, nausea, vomiting, nystagmus, dyskinesia, hallucinations, coma, irregular breathing, hypothermia, bradycardia, hypotension, convulsions, respiratory paralysis and thus respiratory arrest. These substances carry a risk of development of physical addiction of the hard proceeding of abstinence syndrome. In the USA there is a ban on the sale and promotion of these compounds. In Poland despite the fact that GHB is a controlled substance, there is no regulation of GBL trading. The aim of this paper is to summarize current knowledge regarding the pharmacology, impact on the human body, toxicity, and the effects of chronic abuse of these substances.

Topics: 4-Butyrolactone; Acidosis; Amnesia, Retrograde; Drug Overdose; Euphoria; Humans; Sodium Oxybate; Solvents; Substance Abuse Detection; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is naturally present in the human body, but may also be used as an intoxicating drug. Information from several sources has suggested its increased availability and use in Norway. There have also been reports of an increasing use of the chemical precursor gamma-butyrolactone (GBL).There is currently a need for knowledge on symptoms, addictiveness and overdoses, as well as targeted preventive measures.. The article is based on a discretionary selection of articles resulting from a literature search in PubMed, as well as reports from Norwegian and European authorities and research institutions.. An intake of small amounts of GHB produces an intoxicating effect, whereas higher doses can result in poisoning. Deaths have been reported. The effect may be variable, due to a steep dose-response curve and interaction with alcohol and other intoxicants. Treatment of poisoning is symptomatic and supportive. Treatment of abstinence is also supportive, while delirium may be treated as delirium tremens.. Preventive measures should be tailored specifically to potential user-groups.

Topics: 4-Butyrolactone; Citric Acid Cycle; Drug Overdose; Europe; Humans; Illicit Drugs; Norway; Sodium Oxybate; Solvents; Substance Withdrawal Syndrome; Substance-Related Disorders

This study reviewed the cumulative postmarketing and clinical safety experience with sodium oxybate (Xyrem), a treatment approved for cataplexy and excessive daytime sleepiness in narcolepsy. Study objectives were to investigate the occurrence of abuse/misuse of sodium oxybate since first market introduction in 2002, classify cases using DSM-IV criteria for substance abuse and dependence, and describe specific characteristics of these cases.. We retrospectively reviewed postmarketing spontaneous adverse event (AE) reports from 15 countries for all cases containing reporting terminology related to abuse/misuse to determine its occurrence. All death cases independent of causality were reviewed to identify associated risk factors.. Approximately 26,000 patients worldwide received sodium oxybate from first market introduction in 2002 through March 2008. Of those 26,000 patients, 0.2% reported > or = 1 of the events studied. These included 10 cases (0.039%) meeting DSM-IV abuse criteria, 4 cases (0.016%) meeting DSM-IV dependence criteria, 8 cases (0.031%, including 3 of the previous 4) with withdrawal symptoms reported after discontinuation of sodium oxybate, 2 confirmed cases (0.008%) of sodium oxybate-facilitated sexual assault, 8 cases (0.031%) of overdose with suicidal intent, 21 deaths (0.08%) in patients receiving sodium oxybate treatment with 1 death known to be related to sodium oxybate, and 3 cases (0.01%) of traffic accidents involving drivers taking sodium oxybate. During this period, approximately 600,000 bottles of sodium oxybate were distributed, and 5 incidents (0.0009%) of diversion were reported.. Cumulative postmarketing and clinical experience indicates a very low risk of abuse/misuse of sodium oxybate.

Topics: Accidents, Traffic; Central Nervous System Depressants; Disorders of Excessive Somnolence; Drug Overdose; Drug Utilization; Drug-Related Side Effects and Adverse Reactions; Humans; Product Surveillance, Postmarketing; Rape; Risk; Sodium Oxybate; Substance-Related Disorders

Topics: Acetaminophen; Alcohols; Analgesics, Opioid; Antidepressive Agents, Tricyclic; Drug Overdose; Humans; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate

Time is a crucial element in preventing the most severe consequences of overdose.

Topics: Acetaminophen; Alcohols; Analgesics, Opioid; Antidepressive Agents, Tricyclic; Drug Overdose; Ethylene Glycol; Humans; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate

Topics: Adult; Cholinesterase Inhibitors; Drug Overdose; Emergencies; Evidence-Based Medicine; Humans; Male; Physostigmine; Sodium Oxybate

A short cut review was carried out to establish whether intubation is always required in patients presenting with a decreased conscious level after gamma-hydroxybutyrate ingestion. Altogether 95 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

Topics: Adult; Anesthetics; Coma; Drug Overdose; Emergency Medicine; Evidence-Based Medicine; Humans; Intubation, Intratracheal; Male; Sodium Oxybate

Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. Severe drug reactions can occur even with a small dose and may require critical care. Club drug over-dose usually resolves with full recovery within seven hours. Education of the patient and family is essential.

Topics: Anesthetics, Dissociative; Drug Overdose; Flunitrazepam; Hallucinogens; Humans; Ketamine; Leisure Activities; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

Topics: Amphetamines; Analgesics, Opioid; Anesthetics, Intravenous; Cocaine; Drug Overdose; Emergency Treatment; Heroin; Humans; Narcotics; Poisoning; Sodium Oxybate; Substance-Related Disorders

During the last six months, the Poison Control Centre at Bispebjerg Hospital, Copenhagen, Denmark, has observed an increasing number of patients intoxicated with GHB, a drug of abuse. The patients are often admitted to the emergency ward shortly after having taken the drug, unconscious or comatose. If younger patients present with these symptoms, intoxication with GHB should be seriously considered. The effects are seen within 15 to 30 minutes after oral ingestion of the drug. Spontaneous recovery usually occurs within three to five hours. The most common effects are mild euphoria, sedation, vomiting, somnolence, bradycardia, aggressive behaviour, apnoea, respiratory depression, and coma. Normally the patient breathes adequately, but insufficient respiration may occur and deaths have been described. The drug is often consumed together with alcohol and other drugs of abuse, which strengthens the effect of GHB. Treatment is symptomatic. A review of the literature with special emphasis on clinical effects included toxicology and treatment is given.

Topics: Central Nervous System Stimulants; Drug Overdose; Emergencies; Humans; Illicit Drugs; Poisoning; Sodium Oxybate; Substance-Related Disorders

gamma-Hydroxybutyric acid (GHB) is unfamiliar to many physicians in the United States but enjoys clinical use elsewhere for applications in resuscitation, anesthesia, and addiction therapy. Use within the United States is restricted to Food and Drug Administration-approved clinical trials for treatment of narcolepsy. Recently illicit use of GHB has emerged within the United States where it is distributed for purported euphoric and "fat-burning" metabolic effects. Clinical effects can be severe, progressing rapidly to respiratory arrest and death. We provide an updated comprehensive review of the literature with particular emphasis on toxicology, including GHB pharmacodynamics, clinical effects, and suggestions for overdose management. Recommended management of acute GHB intoxication includes prevention of aspiration, use of atropine for persistent symptomatic bradycardia, consideration of neostigmine as a reversal agent, and treatment for coingested substances. Emergency physicians are urged to become familiar with GHB because of its potential for severe morbidity as well as its potential use as a future resuscitative agent.

Topics: Adjuvants, Anesthesia; Animals; Drug Overdose; Humans; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is used at disproportionately high rates within sexuality and gender diverse communities and carries a high risk of overdose. GHB overdose can result in death. Internationally, recent increases in GHB overdoses have been observed. Coronial reviews of GHB-related death highlight the pivotal roles that bystanders to GHB overdose play in preventing fatality. No research has examined, in detail, how bystanders respond to GHB overdose. This qualitative study was conducted among people who use GHB and explored how they responded upon witnessing a GHB overdose experienced by someone else.. Interviews were conducted with 31 sexuality and gender diverse Australian residents reporting three or more occasions of GHB use in the previous 12 months. Participants were asked questions about witnessed GHB overdose, their actions and decision-making processes throughout overdose. Data were analysed thematically.. Participants described witnessing GHB overdose, commonly in private settings involving sexualized GHB use. Variable definitions of GHB overdose were reported, ranging from GHB-induced symptoms of distress to comatose intoxication. Drastic actions to keep someone alert and responsive post-GHB ingestion were reported; these included the administration of stimulant substances and citrus. Decisions to call or not call for emergency medical services (EMS) were influenced by many circumstantial variables. In most instances, an EMS call was resisted and response practices deviated from established first aid protocols.. GHB overdose prevention and response training programs targeting people who use GHB are urgently required. These education interventions ought to address inaccuracies that inform street remedies for GHB overdose, teach people how to safely check breathing and response, promote basic first aid principles and address barriers to contacting EMS.

Topics: Attitude; Australia; Drug Overdose; Humans; Mental Disorders; Sodium Oxybate

Gamma-Hydroxybutyrate (GHB) overdoses cause respiratory depression, coma, or even death. Symptoms and severity of poisoning depend on blood-concentrations and individual factors such as tolerance. A retrospective case study was conducted, evaluating GHB intoxication cases. GHB-concentrations in blood and urine were determined by gas chromatography-mass spectrometry (GC-MS) along with, in part, via enzymatic assay. GHB-concentrations, demographic data, and additional drug use, as well as specific clinical information, were evaluated. The correlation between GHB-levels in blood and associated symptoms were examined. In total, 75 cases originating from the Emergency Departments (EDs) of Hamburg and surrounding hospitals were included. Fifty-four of the patients (72%) were male. The mean GHB-concentration in blood was 248 mg/L (range 21.5-1418 mg/L). Out of the group with detailed clinical information (n = 18), the comatose group (n = 10/18) showed a mean of 244 mg/L (range 136-403 mg/L), which was higher than that of the somnolent and awake patients. Of the comatose collective, 70% (n = 7) showed co-use of one or more substances, with the additional use of cocaine being the most frequently detected (n = 5). In conclusion, a moderate dose-effect relationship was observed, although, there was some overlap in dosage concentration levels of GHB in awake and comatose patients. In GHB-intoxication cases, co-use was common as were clinical effects such as acidosis, hypotension, and impact on the heart rate. Timely analytical determination of the GHB-concentration in blood could support correct diagnosis of the cause of unconsciousness.

Topics: Coma; Drug Overdose; Humans; Male; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders

GHB is used among some sexuality and gender diverse populations at elevated rates, however little qualitative research has explored GHB use among these populations with regards to diverse contexts, settings, practices, and experiences of use. Internationally, harms relating to GHB overdose appear to be increasing. Research outlining consumers' experiences of GHB-related pleasures and their strategies to reduce harms may inform GHB education and intervention responses.. N = 31 participants reporting three or more occasions of GHB use within the previous 12 months were recruited via digital advertising and snowball methods. Semi-structured interviews were conducted, data were transcribed and analysed in NVivo using a thematic framework analysis. Emergent themes were charted, and divergences and convergences were considered with regards to the sexuality and gender identities of participants.. Pleasures associated with GHB were described in relation to the sensation of the GHB high and experiences of intimacy, and connection. GHB was used to enhance socialising and sex in domestic, private, and commercial venues. Participants prioritised terminology of 'control' when describing their practices associated with GHB dosing, measuring, timing and peer moderation. Most participants reported personal experience of GHB overdose with loss of consciousness.. Participants' near-ubiquitous experience of GHB overdose highlights ongoing education needs around overdose prevention. Efforts must target people new to GHB use who appeared particularly susceptible to overdose. Inconsistencies in understandings around GHB overdose, the perceived severity of overdose and the differences between GHB and its precursors GBL and 1,4-BD, highlight potential focus areas of future education responses. Further research is required to better understand consumers' experiences of sexual violence in the context of GHB use.

Topics: Drug Overdose; Gender Identity; Humans; Pleasure; Sexual Behavior; Sexuality; Sodium Oxybate

Although the prevalence of gamma-hydroxybutyrate (GHB) use is relatively low globally, harms related to the drug appear to be increasing. Few existing studies present reliable, representative, population-level data on GHB-related harms. The aim of this study was to investigate trends in acute GHB-related harms within an ambulance database in Australia.. Cross-sectional, retrospective analysis of data on all GHB-related ambulance attendances in the state of Victoria, Australia during a 7-year period (January 2012-December 2018) MEASUREMENTS: Presentations were characterized based on patient demographics, transport to hospital, co-occurring substance use (i.e. GHB only, alcohol, methamphetamine, heroin, benzodiazepine and cannabis) and clinical presentation (e.g. symptoms of anxiety, psychosis, depression).. There were 5866 GHB-related ambulance attendances between 2012 and 2018, with the prevalence rate increasing from 8.8 per 100 000 population in 2012 to a maximum of 21.7 per 100 000 population in 2017. Methamphetamine [odds ratio (OR) = 6.23, P < 0.001] and benzodiazepine-related (OR = 1.43, P < 0.001) co-occurrences; ages between 18-29 (OR = 6.58, P < 0.001) and 30-39 years (OR = 2.02, P < 0.001); and male gender (OR = 1.23, P < 0.001) were significant predictors of GHB-related attendances.. There has been a 147% increase in the prevalence of GHB-related ambulance attendances in Victoria, Australia between 2012 and 2019, largely attributable to a growth in the proportions of people using gamma-hydroxybutyrate alone or concurrently with methamphetamine.

Topics: Adolescent; Adult; Ambulances; Cross-Sectional Studies; Datasets as Topic; Drug Overdose; Emergency Medical Services; Female; Humans; Male; Methamphetamine; Middle Aged; Prevalence; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Victoria; Young Adult

Many patients with gamma-hydroxybutyrate (GHB) poisoning are treated at the emergency primary health care (A&E clinic) level in Oslo. We describe the clinical picture of GHB poisoning and compare hospitalised patients with patients who were discharged from the main A&E clinic in Oslo.. We registered retrospectively all patients with the clinical diagnosis GHB poisoning at the Oslo Accident and Emergency Outpatient Clinic from 1 October 2013 to 30 September 2015. We only included cases where GHB was taken as an intoxicant.. We found 329 cases of GHB poisoning in the period. The median age was 30 years (interquartile range 25-36 years, range 15-56 years), and 228 (69 %) of the cases were men. GHB was taken as the only intoxicant in 128 cases (39 %), combined with alcohol in 96 (29 %) and with amphetamine in 65 (20 %). Reduced level of consciousness was observed in 218 cases (69 %), coma (Glasgow Coma Scale score ≤ 7) in 43 (14 %) and agitation in 117 (36 %). Compared with patients who were discharged from the A&E clinic, the 159 hospitalised patients (48 % of the total number) were more often comatose (23 % vs 5 %, p < 0.001) and agitated (43 % vs 28 %, p = 0.008). The median observation time at the A&E clinic prior to hospitalisation was 42 minutes (interquartile range 26 min - 1 h 23 min, range 2 min - 20 h 10 min) vs 3 h 1 min (interquartile range 1 h 32 min - 4 h 42 min, range 14 min - 15 h 37 min) for those who were discharged from the A&E clinic (p < 0.001).. Half of the patients with GHB poisoning were only treated at A&E clinic level. Many of those who were hospitalised had severe symptoms that quickly called for hospitalisation.

Topics: Adult; Ambulatory Care Facilities; Drug Overdose; Emergency Service, Hospital; Female; Humans; Male; Poisoning; Retrospective Studies; Sodium Oxybate

Topics: Acidosis; Continuous Renal Replacement Therapy; Drug Overdose; Humans; Sodium Oxybate

The use of GHB is still widespread with many hospitalised overdose cases.. A man in his fifties was found unconscious in the street and brought to our Acute Admissions. When first examined he was still unconscious, hypothermic, had snoring respiration and smelled of alcohol. He was otherwise haemodynamically stable. Blood samples showed elevated osmolal and anion gaps. The increase in the osmol gap could be explained by the ethanol level of 210 mg/dL (46 mmol/L), but the reason for the increased anion gap was unknown. Flumazenil and naloxone were administered without effect. As the ethanol concentration alone was unlikely to explain the clinical picture, extended toxicological tests were performed. GHB in plasma was very high (5.0 mmol/L; 520 mg/L) even though the sample was taken almost 4 hours after admission. The GHB concentration (present as an anion) corresponded to the increased anion gap. The patient was comatose for approximately 12 hours, which is unusually long in GHB poisoning.. Intoxication with GHB is important to consider in comatose patients where other causes are excluded. Prolonged clinical course may be due to a saturation of the GHB metabolism after a large dose or ingestion of GBL or 1,4-butanediol, both of which are precursors to GHB.

Topics: Acid-Base Equilibrium; Coma; Drug Overdose; Ethanol; Humans; Male; Sodium Oxybate; Unconsciousness

Somnophilia, the desire to have sex with an unconscious, sleeping, or comatose person who is unable to respond, is a sexual paraphilia that is seldom reported. The underlying desire is often overshadowed by the act of sexual violation and when using GHB or GBL to induce unconsciousness, as in the case presented here, the victim might not even be able to recall, for certain, that they have been sexually violated. A case study is offered of a somnophile who adulterated drinks to render young men unconscious, so he could rape them in that state, before progressing to administering drugs anally on the pretext of applying lubrication to the anus to facilitate sexual intercourse. The offender's fetishistic compulsion to have sex with unconscious men propelled him to experiment with the means by which he surreptitiously administered drugs to his victims in order to deepen their comatose state.

Topics: 4-Butyrolactone; Coma; Drug Overdose; Homicide; Humans; Hypnotics and Sedatives; Male; Paraphilic Disorders; Rape; Sodium Oxybate

Female drug users report poorer physical and mental health than male drug users. We describe female and male patients treated for acute recreational drug toxicity, and look for gender differences in clinical state, treatment, and toxic agents taken.. Retrospective case series from a primary care emergency outpatient clinic and a hospital emergency department in Oslo, Norway. All patients treated for acute recreational drug toxicity from October 2013 through March 2015 were included, except patients with lone alcohol intoxication. Patients were grouped according to whether they had taken opioids or not, as a proxy differentiation between heavy drug users and party drug users. Data from the two clinical settings were analysed separately.. In total, 2495 cases were included, 567 (22.7%) were women. Female patients were younger than males, median 31 vs 34 years (p < 0.001). On most comparisons of clinical variables there were no significant differences between genders. A larger proportion of females in the outpatient opioid group were hypotensive, 10.9% vs 3.9% (p < 0.001). Fewer females were intubated, none vs 21.1% (p = 0.019) in the hospital opioid group, and 6.4% vs 21.0% (p = 0.039) in the hospital non-opioid group. The proportion of gamma-hydroxybutyrate (GHB) poisoning was larger among females both at the outpatient clinic (14.4% vs 8.6%, p < 0.001) and at the hospital (60.3% vs 36.4%, p = 0.001), while the proportion of heroin poisoning was smaller among females at the outpatient clinic (37.1% vs 47.0%, p < 0.001).. One in four patients treated for acute recreational drug toxicity were women. Female patients were younger, had more frequently taken GHB and were less frequently intubated. Otherwise, the gender differences regarding clinical state and treatment were small. Although female drug users are known to report poorer health than males, we did not find that women had a more severe clinical course than men when presenting with overdose.

Topics: Adult; Analgesics, Opioid; Drug Overdose; Emergency Service, Hospital; Female; Heroin; Humans; Illicit Drugs; Male; Middle Aged; Norway; Retrospective Studies; Sex Distribution; Sodium Oxybate; Young Adult

We report a case of fatal intoxication from 1,4-butanediol (1,4-BD), which was ingested by a young and "naïve" gamma-hydroxybutyrate (GHB) consumer during a party with the co-ingestion of alcohol, cannabis, and methylene-dioxy-methamphetamine. The following drug concentrations were found using gas chromatography coupled with mass spectrometry on autopsy samples and on a cup and a glass found at the scene: 20,350 mg/L (bottle) for 1,4-BD; 1020 mg/L (femoral blood), 3380 mg/L (cardiac blood), 47,280 mg/L (gastric content), and 570 mg/L (vitreous humor) for GHB. The concentration of GHB is difficult to interpret in forensic cases due to the possibility of an endogenous production of GHB. The variable tolerance of the user may also modify the peri- and postmortem GHB concentrations. This case underscores the need to have many different sources of toxicology samples analyzed to avoid the hypothesis of endogenous production of GHB.

Topics: Adult; Butylene Glycols; Central Nervous System Depressants; Dronabinol; Drug Overdose; Ethanol; Gas Chromatography-Mass Spectrometry; Gastrointestinal Contents; Humans; Male; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Vitreous Body

Gamma-hydroxybutyrate (GHB) overdose is an important concern in the Netherlands and Flanders, Belgium and accounts for most overdoses reported by emergency services. Few stu dies have focused on GHB overdose. Appropriate public health responses have yet to be developed. We report an explorative survey of people who use GHB and their experience with GHB overdose, aiming to identify risk and protective factors associated with comatose intoxication after GHB ingestion.. We conducted a cross-sectional survey of GHB consumers from different GHB consumption contexts. Between May and October 2014, 146 respondents were recruited in both the urban Randstad and in smaller towns in the Netherlands and Flanders, using a variety of sampling methods. Descriptive statistics were used to describe demographic, social economic, drug use, environmental variables and the experience of overdose and GHB induced coma in the resulting convenience sample. Multivariate CHAID (Chi-quadrat automatic interaction detector) was used in exploring interactions with overdose.. All study respondents were poly drug consumers. We identified several factors associated with coma. The strongest relationship was found between coma and the lifetime number of GHB consumption episodes. Using alone, the number of doses per consumption episode (stacking) and the living region were strongly associated with GHB overdose as well. In the Netherlands, heavy, high risk GHB consumption is primarily found among poorly educated young adolescents in economically less privileged provincial communities.. We found extremely high rates of comatose intoxication after GHB use and the strongest association with GHB overdose concerned the lifetime number of GHB consumption episodes. Poly-drug consumption appears to be the norm in our entire sample, but does not necessarily distinguish heavy or high risk consumption from more recreational use. Using in the company of friends may offer some level of protection against GHB overdose. Overdose prevention, stabilizing heavy and harmful drug consumption patterns and reducing the harms associated therewith should become an important priority in the Dutch response to GHB.

Topics: Adolescent; Adult; Belgium; Coma; Cross-Sectional Studies; Drug Overdose; Drug Users; Female; Health Surveys; Humans; Male; Middle Aged; Netherlands; Protective Factors; Risk Factors; Rural Population; Sodium Oxybate; Urban Population; Young Adult

To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse.. We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes.. We included 710 cases (83% males, mean age 31 years), representing 12.6% of the total cases attended for drug intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly during weekend, and 71.7% consumed GHB/GBL in combination with other substances of abuse, the most frequent additional agents being ethanol (50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among 15 clinical features pre-defined in the project database, the 3 most frequently identified were altered behaviour (39%), reduced consciousness (34%) and anxiety (14%). The severity ranged from mild cases requiring no treatment (308 cases, 43.4%) to severe cases requiring admission to intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases, 6.9%). No deaths were reported. In comparison with only GHB/GBL consumption, patients consuming GHB/GBL with co-intoxicants presented more vomiting (15% vs. 3%, p<0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p<0.05), a greater need for treatment (59.8% vs. 48.3%, p<0.01) and a longer ED stay (11.3% vs. 3.6% patients with ED stay >12h, p<0.01).. The profile of the typical GHB/GBL-intoxicated European is a young male, requiring care for altered behaviour and reduced level of consciousness, mainly during the weekend. The clinical features are more severe when GHB is consumed in combination with other substances of abuse.

Topics: 4-Butyrolactone; Adult; Akathisia, Drug-Induced; Consciousness; Drug Interactions; Drug Overdose; Emergency Service, Hospital; Europe; Female; Humans; Illicit Drugs; Intubation, Intratracheal; Male; Motor Activity; Prospective Studies; Respiration, Artificial; Severity of Illness Index; Sodium Oxybate; Substance-Related Disorders; Time Factors; Treatment Outcome

Topics: 4-Butyrolactone; Bisexuality; Drug Overdose; Emergency Service, Hospital; Female; Homosexuality, Male; Humans; Male; Pilot Projects; Referral and Consultation; Sexual Health; Sodium Oxybate

Topics: Adult; Alcoholic Beverages; Chromatography, High Pressure Liquid; Drug Contamination; Drug Overdose; Homosexuality, Male; Humans; Illicit Drugs; Male; Sexual Partners; Sildenafil Citrate; Sodium Oxybate; Tandem Mass Spectrometry

Many patients present to emergency departments (EDs) with an altered state of consciousness. Fast exclusion of gamma hydroxybutyrate (GHB)-associated intoxication in these patients may optimize diagnostic and therapeutic algorithms and decisions in the ED.. Between January and March 2014, a novel enzymatic test system was used to quantify GHB in blood and urine samples of suspected intoxicated patients in the ED of the University Hospital. The underlying causes for suspected intoxication and the diagnostic and therapeutic measures were documented and analysed retrospectively.. GHB measurements were performed in 13 patients with suspected ingestion during a 3-month study period. GHB was positive in six patients showing serum levels between 61.8 mg/l and 254.8 mg/l, and GHB was tested negative in seven patients with a range of 0.3-6.2 mg/l (upper reference limit 6.1 mg/l). Additional intoxication was found in five of six GHB positive (83%, alcohol n = 2 and other drugs n = 5) and in six of seven negative-tested patients (86%, alcohol n = 5 and other drugs n = 1).. GHB quantification in the ED provides specific additional information for intoxication, which can lead to more precise diagnostic and therapeutic decisions and may also be important for legal aspects. We believe that GHB analysis in unconscious patients with suspected intoxication may improve the efficient treatment of intoxicated patients.

Topics: Adult; Decision Making; Drug Overdose; Emergency Service, Hospital; Female; Germany; Half-Life; Humans; Illicit Drugs; Limit of Detection; Male; Retrospective Studies; Sodium Oxybate; Substance Abuse Detection

γ-Hydroxybutyrate (GHB) is a drug of abuse with dose-dependent sedative effects. Systematic data on the acute toxicity of GHB from emergency department (ED) presentations over a long period of time are currently missing from the literature. The present study described the clinical features of GHB toxicity.. Retrospective case series of GHB intoxications seen in an urban ED.. From January 2002 to September 2015, 78 GHB-related intoxication cases were recorded (71 % male patients). The mean ± SD age was 29 ± 8 years. The co-use of alcohol and/or other illicit drugs was reported in 65 % of the cases. Neurological symptoms other than central nervous system depression included agitation (40 %) and clonus (21 %). The most frequent reasons for admission were coma (64 %) and agitation (23 %). The median time to regain consciousness was 90 min (range, 3-400 min). Sudden recovery was reported in 25 cases (32 %). Coma was not significantly associated with polyintoxication. Coma occurred in 77 % of the alcohol co-users and in 62 % ofthe non-alcohol users (p=0.052). The mean recovery time in comatose patients was 142 min in patients with co-use of alcohol compared with 89 min in patients without alcohol co-use (p=0.07). Alcohol co-use was not significantly associated with nausea/vomiting (p=0.07). The co-use of stimulants was not significantly associated with non-responsive coma (Glasgow Coma Scale = 3) or mean recovery time. Analytical confirmation of GHB was available in 37 cases (47 %), with additional quantitative analysis in 20 cases. The median GHB concentration was 240 mg/L (range, 8.3-373 mg/L). Intoxication was severe in 72 % of the cases. No fatalities occurred, and 72 % of the patients were discharged directly home from the ED.. There were trend associations between alcohol co-use and frequency and length of coma and nausea/vomiting which did not reach the significance level (all p=0.05-0.07) but may nevertheless be clinically relevant. As the exact time of use is not always known, and co-use of other substances can affect the severity of poisoning, no definitive conclusions can be drawn regarding the association between GHB concentration and severity.. Impaired consciousness and agitation were typical findings of GHB intoxication. The co-use of alcohol and/or other illicit substances is common but was not significantly associated with the severity of the intoxications in our study.

Topics: Adolescent; Adult; Diagnosis, Differential; Drug Overdose; Female; Follow-Up Studies; Hospitals, Urban; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Sodium Oxybate; Switzerland; Young Adult

Monocarboxylate transporter (MCT) inhibition represents a potential treatment strategy for γ-hydroxybutyric acid (GHB) overdose by blocking its renal reabsorption in the kidney. This study further evaluated the effects of a novel, highly potent MCT inhibitor, AR-C155858, on GHB toxicokinetics/toxicodynamics (TK/TD).. Rats were administered GHB (200, 600 or 1500 mg/kg i.v. or 1500 mg/kg po) with and without AR-C155858. Breathing frequency was continuously monitored using whole-body plethysmography. Plasma and urine samples were collected up to 8 h. The effect of AR-C155858 on GHB brain/plasma partitioning was also assessed.. AR-C155858 treatment significantly increased GHB renal and total clearance after intravenous GHB administration at all the GHB doses used in this study. GHB-induced respiratory depression was significantly improved by AR-C155858 as demonstrated by an improvement in the respiratory rate. AR-C155858 treatment also resulted in a significant reduction in brain/plasma partitioning of GHB (0.1 ± 0.03) when compared to GHB alone (0.25 ± 0.02). GHB CLR and CLoral (CL/F) following oral administration were also significantly increased following AR-C155858 treatment (from 1.82 ± 0.63 to 5.74 ± 0.86 and 6.52 ± 0.88 to 10.2 ± 0.75 ml/min/kg, respectively).. The novel and highly potent MCT inhibitor represents a potential treatment option for GHB overdose.

Topics: Administration, Intravenous; Administration, Oral; Animals; Antidotes; Brain; Cell Line; Drug Overdose; Kidney; Male; Metabolic Clearance Rate; Monocarboxylic Acid Transporters; Rats, Sprague-Dawley; Renal Reabsorption; Respiratory Insufficiency; Respiratory Rate; Sodium Oxybate; Thiophenes; Tissue Distribution; Uracil

Chemsex is a colloquial term used by gay men in some parts of the UK to describe the use of psychoactive substances (typically mephedrone, GHB/GBL or crystal methamphetamine) during sex. Use of these drugs by gay men in London appears to have risen sharply from relatively low levels and, as yet, there is little data to inform appropriate harm reduction services. This study sought to understand the personal and social context of chemsex and the nature of harm reduction need.. In-depth interviews were conducted with 30 self-identifying gay men (age range 21-53) who lived in three South London boroughs, and who had used either crystal methamphetamine, mephedrone or GHB/GBL either immediately before or during sex with another man during the previous 12 months. Data were subjected to a thematic analysis.. While around half of participants had utilised a range of drugs over many years, others had only recently been introduced to drugs, often by sexual partners who wished to enhance the sexual session. As relatively new drugs on the gay scene, understanding of appropriate dosing was lacking and a majority described overdoses, particularly in relation to GHB/GBL. Negotiation of sex, especially in group sex environments, was complicated by the effects of the drugs and a small number of men reported concerns relating to sexual consent. While a significant proportion of men had experienced a range of physical and mental health harms, few had accessed professional support for fear of judgement or concern about chemsex expertise.. Findings from this study indicate a substantial degree of harm in the usage of relatively new psychoactive substances in highly sexual circumstances. Generic drug services, typically designed to address the needs of opiate users, may not be sufficiently resourced to address the specific and acute needs of gay men engaging in chemsex.

Topics: 4-Butyrolactone; Adult; Drug Overdose; Harm Reduction; Homosexuality, Male; Humans; London; Male; Methamphetamine; Middle Aged; Needs Assessment; Self Medication; Sexual Behavior; Sodium Oxybate; Young Adult

The aim of this study was to identify in recreational drug users the factors which increase the risk of overdosing (OD) with γ-hydroxybutyrate (GHB). A purposive sample of 45 experienced GHB users was interviewed, equally divided into three groups (never OD, occasional OD, and repeat OD). The repeat OD group scored highest on many risk factors regarding GHB use, the occasional OD group scored intermediate, and the never OD group scored lowest. Participants, whether or not they had overdosed on GHB, most often perceived GHB use (e.g. using more GHB than usual, using GHB doses too closely together) as the main reason for GHB OD, and many participants who had overdosed on GHB reported that they had taken more GHB than usual at their most recent occasion of GHB OD. No significant differences in co-use of GHB with other substances were found between the three groups. Our findings indicate that using GHB in the company of groups of friends probably reduces, but does not eliminate, the risk of OD.

Topics: Adolescent; Adult; Drug Overdose; Female; Humans; Illicit Drugs; Male; Netherlands; Risk Factors; Self Report; Sodium Oxybate; Substance-Related Disorders; Young Adult

Acute poisoning with gamma-hydroxybutyrate (GHB) has been a serious medical and social problem in different parts of the world including Sweden. GHB is a drug of abuse which acts primarily as central nervous system (CNS) depressants. GHB has serious toxicity, although many young users do not recognise GHB as a dangerous drug. The aim of this pilot study was to explore how symptoms with risk of failure in vital functions would be valued among professionals that encounter GHB intoxication in the emergency phase.. A web-based survey focusing on the assessment of vital clinical signs for possible GHB intoxication using a numeric scale was carried out during April and May 2011. The participants, n 105, are all professionals who encounter GHB intoxicated in the emergency phase, but have different levels of training in GHB intoxication, mainly Registered Nurses (RNs) in southwest Sweden, employed in pre-hospital or emergency departments at somatic and most psychiatric health care facilities, as well as police officers who in their work come into contact with drug users. Responses in the survey were scored according to risk of GHB intoxication with serious failure of vital functions. The score value was then referred to a so-called evidence based priority (EBP) scale and analysed using descriptive statistics and Fisher's exact test.. Cardiac arrest, coma, hypoxia, general convulsions, slow respiratory and heart rate and pale skin are symptoms with the highest risk of serious failure in vital physical functions and were predominantly recognised as such.. Despite the professionals' different levels of training in GHB intoxication, all of them were relatively well aware of and in accordance regarding the most risky symptoms. The interpretation score for the less risky symptoms and signs of GHB intoxication varied depending on their degree of training. The results should be viewed cautiously, as the size of the professional groups and their general knowledge of critical symptoms of GHB poisoning varied.

Topics: Adjuvants, Anesthesia; Adult; Cross-Sectional Studies; Diagnosis, Differential; Drug Overdose; Emergencies; Emergency Service, Hospital; Female; Humans; Male; Severity of Illness Index; Sodium Oxybate

Overdose of γ-hydroxybutyrate (GHB) can result in severe respiratory depression. Monocarboxylate transporter (MCT) inhibitors, including L-lactate, increase GHB clearance and represent a potential treatment for GHB intoxication. GHB can also affect L-lactate clearance, and L-lactate has been reported to affect respiration. In this research, we characterize these toxicokinetic/toxicodynamic interactions between GHB and L-lactate using mechanistic modeling. Plasma, urine, and respiration data were taken from our previous study in which GHB and sodium L-lactate were administered alone and concomitantly in rats. A model incorporating active renal reabsorption for both agents fit GHB and L-lactate toxicokinetic data. The Km for renal reabsorption of GHB (650 μg/mL) was close to its Km for the proton-dependent MCT1 and that for L-lactate (13.5 μg/mL) close to its Km for the sodium-dependent SMCT1. Inhibition of reabsorption by both agents was necessary to model concomitant drug administration. The metabolic Km for L-lactate closely resembled that for MCT-mediated hepatic uptake in vitro, and GHB inhibited this process. L-lactate significantly inhibited respiration at a high dose, and an indirect response model was used to fit these data. GHB toxicodynamics was modeled as a direct effect delayed by nonlinear transport into the brain extracellular fluid, with a Km value of 1,865 μg/mL for brain uptake which is similar to the in vitro Km value determined in rat brain endothelial cells. This model was useful for characterizing multiple MCT-mediated interactions. Incorporation of many parameters that can be determined in vitro may allow for clinical translation of these interactions.

Topics: Anesthetics, Intravenous; Animals; Computer Simulation; Dose-Response Relationship, Drug; Drug Overdose; Lactic Acid; Male; Monocarboxylic Acid Transporters; Rats; Rats, Sprague-Dawley; Respiratory Mechanics; Sodium Oxybate; Symporters; Toxicokinetics

The objective was to examine the effect of endotracheal intubation on emergency department (ED) length of stay (LOS) and admission rates for patients with gamma-hydroxybutyrate (GHB) overdose.. A 3-year retrospective electronic and paper audit of recreational drug presentations was carried out at two major inner-city EDs in Melbourne, Australia. Different GHB overdose management strategies exist at the respective audit sites, namely: 1) all patients with a Glasgow Coma Scale (GCS) score of 8 or less are intubated or 2) uncomplicated patients with GCS scores of 8 or less are managed without intubation (conservative management), unless further complications arise. This difference allows for comparison of the effects of intubation. All suspected GHB-related cases (defined as cases where GHB or its analogs gamma-butyrolactone or 1,4-butanediol were recorded) in which altered consciousness state was noted as a presenting symptom at triage were selected from all recreational drug-related presentations occurring between January 2008 and December 2010. The relationship between intubation and the primary outcome, ED LOS, was examined using robust regression after adjustment for potential confounders. The relationship between intubation and admission status (admission to hospital versus discharge) was also examined using logistic regression.. After adjustment for potential confounders such as GCS score, intubation of GHB-related cases in the ED was associated with an increase in mean LOS of 41% (95% confidence interval [CI] = 19% to 65%) and an increase in the odds of admission to hospital of 9.95 (95% CI = 2.36 to 41.88) at one hospital site, compared to conservative airway management.. Conservative airway management (no intubation) is associated with shorter ED LOS in cases of uncomplicated GHB-related coma in the ED and may also be associated with lower admission rates for these patients.

Topics: Adult; Anesthetics, Intravenous; Drug Overdose; Emergency Service, Hospital; Female; Follow-Up Studies; Glasgow Coma Scale; Humans; Intubation, Intratracheal; Length of Stay; Male; Retrospective Studies; Sodium Oxybate; Treatment Outcome; Young Adult

γ-Hydroxybutyrate (GHB), a common drug of abuse, is often coingested with ethanol. Increasing renal clearance via monocarboxylate transporter (MCT) inhibition represents a potential therapeutic strategy in GHB overdose, as does inhibition of GABAB receptors. In this study, we investigate toxicokinetic/toxicodynamic interactions between GHB-ethanol and efficacy of treatment options for GHB-ethanol intoxication in rats. Sedation was assessed using the endpoint of return-to-righting reflex. Respiration was assessed using plethysmography. Coadministration of 2.0 g/kg ethanol i.v. with 600 mg/kg GHB i.v. increased sleep time compared with GHB alone. Administration of ethanol to steady-state concentrations of 0.1-0.2% and 0.3-0.4% (w/v) did not affect toxicokinetics of 600 mg/kg GHB i.v., or respiratory rate, but did result in significantly lower peak tidal volumes compared with GHB alone. Oral administration of 2.5 g/kg ethanol had no significant effect on toxicokinetics of 1500 mg/kg orally administered GHB. Pretreatment with specific receptor inhibitors indicated no effect of GABAA receptor inhibition on sleep time or respiratory depression in GHB-ethanol intoxication. GABAB receptor inhibition partially prevented sedation and completely prevented respiratory depression. Ethanol increased fatality when administered at 0.1-0.2% (4 of 10) and 0.3-0.4% (9 of 10) versus 1500 mg/kg GHB i.v. alone (0 of 10). Treatment with the MCT inhibitor, l-lactate, significantly decreased sleep time after GHB-ethanol and decreased fatality at 0.1-0.2% (0 of 10) and 0.3-0.4% ethanol (5 of 10). Treatment with a GABAB receptor antagonist completely prevented fatality at 0.3-0.4% (0 of 10). These data indicate that ethanol potentiates the sedative and respiratory depressant effects of GHB, increasing the risk of fatality. MCT and GABAB receptor inhibition represent potentially effective treatments in GHB-ethanol intoxication.

Topics: Animals; Central Nervous System Depressants; Conscious Sedation; Drug Overdose; Ethanol; GABA-B Receptor Antagonists; Hypnotics and Sedatives; Lactic Acid; Male; Monocarboxylic Acid Transporters; Plethysmography; Poisoning; Rats; Rats, Sprague-Dawley; Respiratory Insufficiency; Respiratory Mechanics; Sodium Oxybate

L-lactate represents a potential treatment for GHB overdose by inhibiting GHB renal reabsorption mediated by monocarboxylate transporters. Our objective was to assess the dose-dependence of L-lactate treatment, with and without D-mannitol, on GHB toxicokinetics/toxicodynamics (TK/TD).. Rats were administered GHB 600 mg/kg i.v. with L-lactate (low and high doses), D-mannitol, or L-lactate (low dose) with D-mannitol. GHB-induced sleep time and GHB plasma, urine and brain extracellular fluid (ECF) concentrations (by LC/MS/MS) were determined. The effect of L-lactate and D-mannitol on the uptake and efflux of GHB was assessed in rat brain endothelial RBE4 cells.. L-lactate treatment increased GHB renal clearance from 1.4 ± 0.1 ml/min/kg (control) to 2.4 ± 0.2 and 4.7 ± 0.5 ml/min/kg after low and high doses, respectively, and reduced brain ECF AUC values to 65 and 25% of control. Sleep time was decreased from 137 ± 12 min (control) to 91 ± 16 and 55 ± 5 min (low and high L-lactate, respectively). D-mannitol did not alter GHB TK/TD and did not alter L-lactate's effects on GHB TK/TD. L-lactate, but not D-mannitol, inhibited GHB uptake, and increased GHB efflux from RBE4 cells.. L-lactate decreases plasma and brain ECF concentrations of GHB, decreasing sedative/hypnotic effects.

Topics: Animals; Brain; Cell Line; Drug Overdose; Humans; Hypnotics and Sedatives; Lactic Acid; Male; Mannitol; Permeability; Rats; Rats, Sprague-Dawley; Sleep; Sodium Oxybate

Respiratory depression and death secondary to respiratory arrest have occurred after oral overdoses of γ-hydroxybutyrate (GHB) and its precursor γ-butyrolactone (GBL). GHB is a substrate for monocarboxylate transporters (MCTs), and increasing GHB renal clearance or decreasing GHB absorption via MCT inhibition represents a potential treatment strategy for GHB/GBL overdose. In these studies, GHB and GBL were administered in doses of 1.92, 5.77, and 14.4 mmol/kg orally with and without MCT inhibition to determine effects of this treatment strategy on the oral toxicokinetics and toxicodynamics of GHB and GBL. The competitive MCT inhibitor l-lactate was administered by intravenous infusion starting 1 hour after GHB and GBL administration. Oral administration of l-lactate and the MCT inhibitor luteolin was also evaluated. Respiratory depression was measured using plethysmography. Intravenous l-lactate, but not oral treatments, significantly increased GHB renal and/or oral clearances. At the low dose of GHB and GBL, i.v. l-lactate increased GHB renal clearance. Due to the increased contribution of renal clearance to total clearance at the moderate dose, increased renal clearance translated to an increase in oral clearance. At the highest GHB dose, oral clearance was increased without a significant change in renal clearance. The lack of effect of i.v. l-lactate on renal clearance after a high oral GHB dose suggests possible effects of i.v. l-lactate on MCT-mediated absorption. The resulting increases in oral clearance improved respiratory depression. Intravenous l-lactate also reduced mortality with the high GBL dose. These data indicate i.v. l-lactate represents a potential treatment strategy in oral overdose of GHB and GBL.

Topics: 4-Butyrolactone; Absorption; Administration, Oral; Animals; Dose-Response Relationship, Drug; Drug Overdose; Humans; Injections, Intravenous; Kidney; Lactic Acid; Male; Metabolic Clearance Rate; Monocarboxylic Acid Transporters; Rats; Rats, Sprague-Dawley; Respiratory Insufficiency; Sodium Oxybate

Gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) have been profiled as 'party drugs' used mainly at dance parties and in nightclubs on weekend nights. The purpose of this study was to examine the frequency of injecting drug use among GHB/GBL overdose patients and whether there are temporal differences in the occurrence of GHB/GBL overdoses of injecting drug and recreational drug users.. In this retrospective study, the ambulance and hospital records of suspected GHB- and GBL overdose patients treated by the Helsinki Emergency Medical Service from January 1st 2006 to December 31st 2007 were reviewed. According to the temporal occurrence of the overdose, patients were divided in two groups. In group A, the overdose occurred on a Friday-Saturday or Saturday-Sunday night between 11 pm-6 am. Group B consisted of overdoses occurring on outside this time frame.. Group A consisted of 39 patient contacts and the remaining 61 patient contacts were in group B. There were statistically significant differences between the two groups in (group A vs. B, respectively): history of injecting drug abuse (33% vs. 59%, p = 0.012), reported polydrug and ethanol use (80% vs. 62%, p = 0.028), the location where the patients were encountered (private or public indoors or outdoors, 10%, 41%, 41% vs. 25%, 18%, 53%, p = 0.019) and how the knowledge of GHB/GBL use was obtained (reported by patient/bystanders or clinical suspicion, 72%, 28% vs. 85%, 10%, p = 0.023). Practically all (99%) patients were transported to emergency department after prehospital care.. There appears to be at least two distinct groups of GHB/GBL users. Injecting drug users represent the majority of GHB/GBL overdose patients outside weekend nights.

Topics: 4-Butyrolactone; Adult; Drug Overdose; Emergency Medical Services; Female; Finland; Humans; Illicit Drugs; Male; Retrospective Studies; Sodium Oxybate; Substance Abuse, Intravenous; Substance-Related Disorders; Urban Population; Young Adult

Overdose of γ-hydroxybutyrate (GHB) frequently causes respiratory depression, occasionally resulting in death; however, little is known about the dose-response relationship or effects of potential overdose treatment strategies on GHB-induced respiratory depression. In these studies, the parameters of respiratory rate, tidal volume, and minute volume were measured using whole-body plethysmography in rats administered GHB. Intravenous doses of 200, 600, and 1500 mg/kg were administered to assess the dose-dependent effects of GHB on respiration. To determine the receptors involved in GHB-induced respiratory depression, a specific GABA(B) receptor antagonist, (2S)-(+)-5,5-dimethyl-2-morpholineacetic acid (SCH50911), and a specific GABA(A) receptor antagonist, bicuculline, were administered before GHB. The potential therapeutic strategies of receptor inhibition and monocarboxylate transporter (MCT) inhibition were assessed by inhibitor administration 5 min after GHB. The primary effect of GHB on respiration was a dose-dependent decrease in respiratory rate, accompanied by an increase in tidal volume, resulting in little change in minute volume. Pretreatment with 150 mg/kg SCH50911 completely prevented the decrease in respiratory rate, indicating agonism at GABA(B) receptors to be primarily responsible for GHB-induced respiratory depression. Administration of 50 mg/kg SCH50911 after GHB completely reversed the decrease in respiratory rate; lower doses had partial effects. Administration of the MCT inhibitor l-lactate increased GHB renal and total clearance, also improving respiratory rate. Administration of 5 mg/kg SCH50911 plus l-lactate further improved respiratory rate compared with the same dose of either agent alone, indicating that GABA(B) and MCT inhibitors, alone and in combination, represent potential treatment options for GHB-induced respiratory depression.

Topics: Animals; Bicuculline; Dose-Response Relationship, Drug; Drug Overdose; Male; Morpholines; Rats; Rats, Sprague-Dawley; Receptors, Cell Surface; Respiratory Insufficiency; Sodium Oxybate; Treatment Outcome

Recreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure.. To describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams.. Retrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from January 2010 through May 2011. Main outcome measures Clinical presentation, medical interventions and discharge destination.. Sixty-one patients with GHB intoxication attended medical teams during the study period. The median age was 22 years, and 64% were male. Altered conscious state was present in 89% of attendances, and a GCS <9 in 44%. Hypotension, bradycardia and hypothermia were commonly encountered. Endotracheal intubation was required in three percent of patrons. Median length of stay onsite was 90 minutes. Ambulance transport to hospital was avoided in 65% of presentations.. The deployment of medical teams at dance events and music festivals successfully managed the majority of GHB intoxications onsite and avoided acute care ambulance transfer and emergency department attendance.

Topics: Adjuvants, Anesthesia; Ambulances; Dancing; Drug Overdose; Emergency Medical Services; Female; Humans; Male; Mass Behavior; Mobile Health Units; Music; Prescription Drug Misuse; Retrospective Studies; Social Behavior; Sodium Oxybate; Substance-Related Disorders; Victoria; Young Adult

gamma-Hydroxybutyrate (GHB) is a drug of abuse with a status as being safe. In spite of a reputation of low toxicity, a huge number of deaths associated with this drug have been recorded during recent years in Sweden. It is unclear whether coingestion with other drugs or ethanol causes death in GHB overdoses or whether GHB itself is the main cause of death.. The aim of this study was to analyze the cause of death in GHB-related fatalities seen in our region.. All cases of deaths with GHB during the year 2000-2007 in the region of western Sweden were studied retrospectively. The cases were classified as either GHB poisonings without any, with a minor or a major influence of other drugs on the cause of death.. Twenty-three cases were diagnosed as deaths due to GHB overdose. Ninety-one percent coingested other substances. Ninety-one percent of the decedents were male. Age varied between 16 and 46, with the median age at 25 years. Forty-three percent of the cases were classified as GHB poisonings without any or a minor influence of other drugs on the cause of death. Thirty percent also ingested ethanol. Two patients (9%) were only intoxicated with GHB.. Intoxication with GHB carries some mortality. Combining GHB with ethanol does not explain the many deaths in our region, nor do extremely high plasma concentrations of GHB. The intake of opioids increases the toxicity of GHB. The drug itself has such biological activities that an overdose is dangerous and may lead to death.

Topics: Adolescent; Adult; Central Nervous System Stimulants; Cocaine; Drug Overdose; Female; Hallucinogens; Heroin; Humans; Immunoassay; Male; Marijuana Abuse; Methamphetamine; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Prescription Drugs; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Sweden; Young Adult

To examine the nature and extent of ambulance attendances involving gamma-hydroxybutyrate (GHB) and to compare these with heroin-related attendances in Melbourne, Victoria.. Retrospective analysis of a database of ambulance service records on attendances at non-fatal drug overdoses, March 2001-October 2005.. Patients who took GHB and were attended to by an ambulance, as recorded by Metropolitan Ambulance Service (Melbourne) paramedics.. Transportation to hospital by ambulance; other outcomes included number, age, sex and Glasgow Coma Score (GCS) of patients, characteristics of attendances (in public or private space, others present, police co-attendance).. There were 618 GHB-related ambulance attendances across the 46 months of data collection; 362 involving GHB only and 256 involving the concurrent use of GHB and other drugs. These figures compare to 3723 heroin overdoses observed during the same period. The number of GHB-related attendances increased by around 4% per month, which was a higher rate of increase than that found for heroin overdose attendances. Most patients were younger than 25 years, were attended in public spaces, and had a GCS <10. Around 90% of patients were transported to hospital, compared with 21% of heroin overdose attendances.. Ambulance attendance data can be used to index GHB-associated harms. The clear increases in GHB-related ambulance attendances over time highlights the need for further research on how best to respond to this emergent drug-related harm.

Topics: Adult; Ambulances; Drug Overdose; Emergency Medical Services; Female; Humans; Incidence; Male; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Victoria

Gamma hydroxybutyrate (GHB) is a psychoactive substance with complex neurophysiological activity and significant potential for abuse, addiction, and dangerous toxicity. In this study, a semistructured interview was administered to 17 subjects to investigate GHB use, including: manner of use; setting; positive and negative consequences; other drug history; and sexual practices. Respondents were overwhelmingly male, but otherwise had a broad demographic background. Settings varied from nightclubs to private use at home. There was significant variability in the drug obtained, which subjects found problematic because of the narrow therapeutic window and ease of accidental overdose. Common positive experiences included increased sexual desire, decreased sexual inhibitions, and decreased anxiety. Common negative consequences included oversedation, loss of consciousness, motor incoordination, and mental confusion. Nine subjects reported that they would use GHB again, some despite severe negative consequences. Although most subjects reported negative experiences, only three felt their use was problematic, and none sought treatment for GHB abuse or addiction. Subjects were highly drug-experienced, most commonly using MDMA, ketamine, cocaine, alcohol, and methamphetamine. Some reported that GHB could cause poor decision making in sexual situations. This effect has significant ramifications for issues such as date rape and control of sexually transmitted diseases, such as HIV.

Topics: Adult; Data Collection; Drug Overdose; Female; Humans; Illicit Drugs; Male; Middle Aged; New York City; Risk-Taking; Sexual Behavior; Sodium Oxybate; Substance-Related Disorders; Young Adult

To examine the impact of 'party pills' (PP; herbal highs) on the Auckland City Hospital Emergency Department Overdose Database 2002-2004, and to present figures for five other substances in that database.. Auckland City Hospital's Emergency Department's overdose database was reviewed for 2002, 2003, and 2004 for 'herbal ingestions' and 'party pills' (PP), ecstasy, methamphetamine, GHB, cocaine, and alcohol. Adverse effects attributed to PP were examined.. In 2002, 1 patient presented with PP ingestion; 4 presented in 2003 and 21 in 2004 respectively (p<0.001). Of these 21 patients in 2004, 5 had allegedly ingested PP only and none required medical admission. PP only contributed to 1.58% of the overdose database for 2004.. 'Party pills' appeared to have a minor impact on the overdose database at Auckland City Hospital between 2002 and 2004. There was a significant decrease in GHB presentations from 2003 to 2004 (p<0.001), but no significant fall in stimulant overdose presentations.

Topics: Adolescent; Adult; Amphetamines; Central Nervous System Agents; Cocaine; Databases as Topic; Drug Overdose; Emergency Service, Hospital; Ethanol; Female; Humans; Illicit Drugs; Male; N-Methyl-3,4-methylenedioxyamphetamine; New Zealand; Piperazines; Sodium Oxybate

Physostigmine has been proposed as an antidote for gamma hydroxybutyrate (GHB) intoxication, based on associated awakenings in 1) patients anesthetized with GHB and 2) five of six patients administered physostigmine for GHB intoxication. However, there are neither well-supported mechanisms for physostigmine reversal of GHB effects, supportive animal studies, nor randomized, placebo-controlled trials demonstrating safety, efficacy, or improved outcomes. We sought to determine the outcomes of patients with GHB-induced coma after a physostigmine treatment protocol was instituted in an urban Emergency Department and ambulance service. Our search of medical records located five cases of GHB toxicity, all with co-intoxicants, who received physostigmine. None demonstrated response and, further, there were associated adverse events, including atrial fibrillation (2), pulmonary infiltrates (1) and significant bradycardia (1), and hypotension (1). We also reviewed 18 published GHB toxicity case series for incidence of adverse effects, stimulant co-intoxicants (which may heighten risk of physostigmine), complications, and outcomes of supportive care for GHB toxicity. We conclude that physostigmine is not indicated for reversal of GHB-induced alteration of consciousness; it is not efficacious, it may be unsafe, particularly in the setting of recreational polydrug use; and supportive care results in universally good outcomes.

Topics: Adjuvants, Anesthesia; Adult; Antidotes; Arousal; Cholinesterase Inhibitors; Coma; Drug Overdose; Emergency Medical Services; Humans; Illicit Drugs; Male; Physostigmine; Sodium Oxybate; Treatment Failure

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.

Topics: 4-Butyrolactone; Adolescent; Adult; Alcoholism; Anesthetics, Intravenous; Bradycardia; Case-Control Studies; Coma; Drug Overdose; Female; Humans; Hypothermia; Male; Opioid-Related Disorders; Retrospective Studies; Sodium Oxybate; Solvents

Gamma hydroxybutyrate is increasingly being used recreationally in the United Kingdom. We present a case of gamma hydroxybutyrate overdose associated with paroxysmal sympathetic storm, a phenomenon usually confined to patients who have sustained traumatic brain injury.

Topics: Adult; Blood Pressure; Drug Overdose; Humans; Male; Pulse; Sodium Oxybate; Sympathetic Nervous System

Physostigmine is an acetylcholinesterase inhibitor and can produce fasciculations, seizures, bradycardia, and asystole. gamma-hydroxybutyrate (GHB) increases acetylcholine levels in the central nervous system and can decrease heart rate. Despite this, physostigmine has been proposed as an arousal agent to treat coma from overdoses of GHB. The authors hypothesized that in the setting of severe GHB intoxication, physostigmine would reverse sedation without producing adverse effects such as a decrease in heart rate, seizures, and fasciculations.. GHB intoxication was induced in 20 rats by intraperitoneal injection of 700 mg/kg of the GHB precursor gamma-butyrolactone. One hour later, rats were randomly assigned to receive either physostigmine (0.06 mg/kg) intraperitoneally or an equivalent volume of saline. After administration of physostigmine, rats were continuously monitored by a blinded observer for arousal (return of righting reflex), fasciculations, and seizures. Heart rate and respiratory rate were recorded at 0, 5, 15, and 60 minutes after administration of physostigmine. Data were analyzed using repeated-measures analysis of variance and chi-square test. A pretest sample size calculation determined that 10 rats per group would detect a change in arousal from 0% to 50% and a 10% change in heart rate.. No rats in either group had arousal within one hour (p = 1.0); however, ten of ten physostigmine-treated rats developed signs of physostigmine toxicity (fasciculations, 7; seizures, 3), while no controls developed signs of physostigmine toxicity (p = 0.00). The authors were unable to detect a decrease in heart rate.. Physostigmine did not produce a 50% change in arousal as measured by a return of righting reflex but did produce physostigmine toxicity (fasciculations and seizures) in this rat model of severe GHB intoxication.

Topics: Animals; Arousal; Cholinesterase Inhibitors; Coma; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Overdose; Fasciculation; Heart Rate; Male; Physostigmine; Random Allocation; Rats; Rats, Sprague-Dawley; Reflex; Respiratory Mechanics; Seizures; Sodium Oxybate

The first case in France involving a fatal overdose resulting from the ingestion of gamma-hydroxybutyrate (GHB) is presented. GHB was tested by gas chromatography-mass spectrometry (GC-MS) after precipitation. Briefly, 20 microL of body fluids (blood, bile, urine, gastric contents, or vitreous humor) was pipetted in a glass tube, followed by 20 microL GHB-d6 and 45 microL acetonitrile. After vortex mixing and centrifuging, the supernatant was collected and evaporated to dryness. The residue was derivatized with BSTFA with 1% TMCS for 20 min at 70 degrees C. After injection on a 30-m HP5 MS capillary column, GHB (m/z 233, 204, and 147) and GHB-d6 (m/z 239) were identified by MS. GHB was also tested in pubic hair after incubation in 0.01 N NaOH, neutralization, acidification, extraction in ethyl acetate and derivatization with MTBSTFA, using GC-MS-MS. GHB was positive in all the tested specimens, with the following concentrations 2937, 33,727, 1800, and 2856 mg/L in femoral blood, urine, bile, and vitreous humor, respectively. This seems to be the highest blood concentration ever observed. Postmortem redistribution appears weak, as the concentration in cardiac blood was 3385 mg/L (cardiac blood/femoral blood ratio of 1.15). Oral route was suggested with GHB at 7.08 g in 100 mL of gastric contents. Pubic hair analysis clearly indicated chronic GHB abuse, with concentrations along the shaft in the range 19.4 to 25.0 ng/mg (in comparison with physiological concentrations < 2 ng/mg). Methylenedioxymethamphetamine was present in femoral blood at 144 ng/mL. These results are consistent with an acute fatal overdose of GHB.

Topics: Adult; Body Fluids; Drug Overdose; Fatal Outcome; Gas Chromatography-Mass Spectrometry; Hair; Humans; Male; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

gamma-Hydroxybutyric acid (GHB) is a central nervous system (CNS) depressant and hypnotic which, in recent times, has shown an increasing abuse either as recreational drug (due to its euphoric effects and ability to reduce inhibitions) or as doping agent (enhancer of muscle growth). Analogues of GHB, namely gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD), share its biological activity and are rapidly converted in vivo into GHB. At present, GHB and analogues are placed in the Schedules of Controlled Substances. Numerous intoxications in GHB abusers have been reported with depressive effects, seizures, coma and possibly death. The purpose of the present work was the development of a rapid analytical method based on capillary zone electrophoresis for the direct determination of GHB in human urine and serum at potentially toxic concentrations. Analytical conditions were as follows. Capillary: length 40 cm (to detector), 75 microm i.d.; buffer: 5.0 mM Na(2)HPO(4), 15 mM sodium barbital adjusted to pH 12 with 1.0 M NaOH; voltage: 25 kV at 23 degrees C; indirect UV detection at 214 nm; injection by application of 0.5 psi for 5 s. alpha-Hydroxyisobutyric acid was used as internal standard (IS). Sample pretreatment was limited to 1:8 dilution. Under these conditions, the sensitivity was approximately 3.0 microg/ml (signal-to-noise ratio >3). Calibration curves prepared in water, urine and serum were linear over concentration ranges 25-500 microg/ml with R(2)>/=0.998. Analytical precision was fairly good with R.S.D.<0.60% (including intraday and day-to-day tests). Quantitative precision in both intraday and day-to-day experiments was also very satisfactory with R.S.D.

Topics: Calibration; Doping in Sports; Drug Overdose; Electrophoresis, Capillary; Emergency Medical Services; Humans; Hydrogen-Ion Concentration; Hypnotics and Sedatives; Indicators and Reagents; Reference Standards; Sodium Oxybate; Spectrophotometry, Ultraviolet; Substance-Related Disorders

There has been much publicity regarding the use and abuse of gamma-hydroxybutyrate (GHB, "liquid ecstasy," or "GBH"). GHB has been found to be an endogenous compound but has also been used for various therapeutic applications in addition to illicit use, particularly as a dietary supplement, sexual adjunct, and "party drug." Toxicological analysis was performed using urine and/or plasma specimens from 27 nonfatal instances of suspected GHB intoxication in the United Kingdom between May 1998 and May 2003. GHB was detected in the plasma and urine, invariably with the additional presence of ethanol and other drugs of abuse (eg, amphetamines, cocaine, and morphine). GBL was also detected in the majority of urine specimens analyzed but was not detected in the plasma samples (<10 mg/L). The mean plasma and urine concentrations measured as "total GBL" were found to be 245 mg/L (range 86-551 mg/L) and 1732 mg/L (range 5-5581 mg/L), respectively. This is believed to be the largest compilation of nonfatal cases from the United Kingdom.

Topics: Adolescent; Adult; Child; Chromatography, Gas; Drug Overdose; Female; Hallucinogens; Humans; Male; Mass Spectrometry; Sodium Oxybate; Substance Abuse Detection; United Kingdom

To identify deaths in Australasia associated with overdose of gamma-hydroxybutyrate (GHB) and its precursors (gamma-butyrolactone and 1,4-butanediol).. A retrospective search of medical and scientific information sources, as well as popular newsprint, for the period January 2000-August 2003, with formal clinical, toxicological and forensic evaluation of retrieved data.. Death associated with forensic data implicating GHB or its analogues.. Ten confirmed GHB-associated deaths were identified, with eight considered to be directly attributable to GHB. Only two of these eight cases were positive for ethanol toxicology.. Our study supports the existing evidence that GHB overdose is associated with fatalities, and that fatal overdoses occur in the context of isolated use.

Topics: Adult; Age Distribution; Australia; Cause of Death; Central Nervous System Depressants; Drug Overdose; Female; Humans; Incidence; Male; Registries; Retrospective Studies; Risk Factors; Sex Distribution; Sodium Oxybate; Substance-Related Disorders

Topics: Australia; Drug Overdose; Female; Humans; Incidence; Male; Risk Assessment; Sodium Oxybate; Substance-Related Disorders; Survival Rate

Blood specimens from 146 suspected gamma-hydroxybutyrate (GHB) overdose cases, presenting to an emergency department in Washington State over a 12-month period, were analyzed for GHB and other drugs. Of these 146 patients, GHB was confirmed in approximately one-third of the patients (N = 54), sometimes in potentially toxic concentrations. These patients were aged between 17 and 59 years (median 28 years), and 83% were male. Blood GHB concentrations ranged from 29 to 490 mg/L (mean 137 mg/L; median 103 mg/L). In 36 (67%) of the 54 patients, other drugs were additionally detected. Ethanol was measured in 22 (41%) patients, with concentrations ranging from 0.01 to 0.26 g/100 mL (median 0.04 g/100 mL). Other commonly co-administered drugs included 3,4-methylenedioxymethamphetamine, marijuana, methamphetamine, cocaine, and citalopram. Frequently observed clinical symptoms on admission for the GHB overdose group included copious vomiting, ataxia, lack of gag reflex, respiratory depression, mild acute respiratory acidosis, unconsciousness, and sudden altered states of consciousness. Many patients required intubation, and several became combative and required restraints. The majority of patients were discharged within 6 h of hospital admission. However, despite presenting with similar clinical symptoms on admission, GHB was not confirmed in 92 of the 146 overdose patients, suggesting that GHB overdose cases may frequently be indistinguishable from other drug overdoses or medical conditions.

Topics: Adolescent; Adult; Drug Overdose; Emergency Service, Hospital; Female; Gas Chromatography-Mass Spectrometry; Humans; Male; Middle Aged; Sodium Oxybate; Substance-Related Disorders; Suicide, Attempted

We analysed 141 cases of Gamma-hydroxybutyric acid (GHB) and Gamma-butyrolactone (GBL) intoxication reported by physicians to the Swiss Toxicological Information Centre between 1995 and 2003. GHB and GBL intoxication are associated with considerable morbidity. Multiple drug use is common. Overdosing frequently results in non-reactive coma, which accounts for the severity of the intoxication and the costs occasioned by management.

Topics: 4-Butyrolactone; Adolescent; Adult; Drug Overdose; Female; Humans; Male; Sodium Oxybate; Switzerland

A case report of a male presenting with a gamma-hydroxybutyrate (GHB) induced coma at a gay-oriented dance event is reported. A friend accompanying the patient reported that when the patient started to become stuporous, he attempted to revive him with intranasally administered aliquots of crystal methamphetamine. Such treatment partially counters the hypotonia of GHB induced coma, resulting in "automatic" movements by the patient; however, it does not reverse the cognitive effects of the drug. The result increases the difficulty of medical management. The authors report the physical findings and implications for increased difficulty in managing such patients.

Topics: Adult; Amphetamine; Coma; Drug Interactions; Drug Overdose; Emergencies; Humans; Male; Sodium Oxybate; Substance-Related Disorders

The aim of this study was to examine the correlates, context and risk perceptions regarding gamma-hydroxybutyrate (GHB) overdose among a sample of recreational GHB users in Australia.. A cross-sectional survey of 76 GHB users who were administered a structured interview on GHB use. They were asked a series of questions regarding whether they had ever experienced a GHB overdose, the context of their most recent GHB overdose, and about their perceptions of the risks of GHB overdose.. This sample of GHB users had not had a long or extensive experience with GHB use; despite this, half (53%) had experienced a GHB overdose. This sample of GHB users appeared to be well-educated, employed and a history of either drug treatment or incarceration was uncommon. There were no differences between those who had or had not overdosed in terms of socio-demographic characteristics, extent of other drug use or typical patterns of other drug use when using GHB. However, those who had overdosed on GHB had used it more times during their life-time, and had been using it for a longer period of time.. GHB-related overdoses were common among a sample of GHB users who had only recently begun using the drug. The only apparent distinguishing factor between those who had and had not overdosed on GHB was the amount of experience with GHB use.

Topics: Adult; Anesthetics, Intravenous; Central Nervous System Depressants; Cross-Sectional Studies; Drug Overdose; Female; Humans; Male; New South Wales; Prevalence; Sodium Oxybate; Substance Abuse, Intravenous; Victoria

We discuss a prospective case series of patients who present with a severe gamma-hydroxybutyrate intoxication with confirmatory serum and urine gamma-hydroxybutyrate levels.. Patients with a clinical suspicion of gamma-hydroxybutyrate-like drug overdoses and a Glasgow Coma Scale score of 8 or lower were identified from July 1998 through January 1999. Serial serum specimens and a single urine specimen were collected. The levels of gamma-hydroxybutyrate were performed by gas chromatography-mass spectrometry.. All 16 suspected severe gamma-hydroxybutyrate overdose patients had significant serum or urine levels of gamma-hydroxybutyrate. Serum levels ranged from 45 to 295 mg/L, with a median of 180 mg/L (interquartile range [IQR] 235 to 118 mg/L). Patients who developed a Glasgow Coma Scale score of 3 had serum levels that ranged from 72 to 300 mg/L, with a median of 193 mg/L (IQR 242 to 124 mg/L). The time of awakening ranged from 30 minutes to 190 minutes, with a median of 120 minutes (IQR 150 to 83 minutes). Quantitative serum gamma-hydroxybutyrate levels did not correlate with the degree of coma or the time to awakening. Urine levels ranged from 432 to 2,407 mg/L, with a median of 1,263 mg/L (IQR 1,550 to 796 mg/L). Mild transitory hypoventilation occurred in 5 of the 16 patients.. All of our patients with clinically suspected severe gamma-hydroxybutyrate overdose were confirmed to have significant serum and urine levels of exogenous gamma-hydroxybutyrate. They presented with severe coma that lasted 1 to 2 hours. Transient hypoventilation occurred in one third of these patients.

Topics: Adjuvants, Anesthesia; Adult; Drug Overdose; Emergency Service, Hospital; Female; Gas Chromatography-Mass Spectrometry; Glasgow Coma Scale; Humans; Male; Prospective Studies; Sodium Oxybate

Previously used as a general anesthetic, gamma-hydroxybutyrate is now used as a recreational drug. Not surprisingly, an increasing number of acute overdose cases requiring emergency medical care have been reported and described, especially in the United States.. To determine the number and percentage of gamma-hydroxybutyrate overdoses over a 15-month period and to describe the clinical hallmarks and course of this new drug in overdose.. All toxicological emergencies, including those caused by illicit drug consumption, were recorded for 15 months in an urban public hospital emergency department. Accurate toxicological history was obtained from the patients and, if gamma-hydroxybutyrate was suspected, confirmation was performed by urine mass spectrometry. The study data were compared with data recorded in the same emergency department in 1989.. The total number of toxicological emergencies attended in our emergency department have remained unchanged during the last decade, with a significant decrease in number of opiate overdoses and an increase in the number of cocaine, amphetamine, and gamma-hydroxybutyrate overdoses. During the study period, 104 gamma-hydroxybutyrate overdoses presented to the emergency department (3.1% of all toxicological emergencies), ranking second in illicit drugs requiring emergency consultation. The profile of a patient with gamma-hydroxybutyrate intoxication is well defined: a young individual (23 +/- 5 years), male (64%), emergency department presentation on weekends (90%), with simultaneous ethanol consumption (73%) and ingestion of additional illicit drugs (86%), decrease of consciousness being the main complaint in all cases [16% with Glasgow Coma Scale (GCS) = 3]. Complete recovery without sequelae occurred in all cases.. Health authorities must be aware of the hazards of recreational gamma-hydroxybutyrate, and physicians must be cognizant of this recent cause of coma among youths presenting to the emergency departments.

Topics: Adolescent; Adult; Anesthetics, Intravenous; Drug Overdose; Emergencies; Emergency Service, Hospital; Female; Humans; Male; Sodium Oxybate; Spain; Substance-Related Disorders

Gamma-hydroxybutyrate was introduced as an anesthetic agent in the 1960s and is still used in some countries, despite recognized disadvantages. More recently, it has emerged as a popular recreational drug. We report 3 cases of gamma-hydroxybutyrate overdose, the effects of which were reversed by the administration of low-dose intravenous physostigmine. The origins of this regimen and the case for physostigmine as a potential antidote are described.

Topics: Adult; Antidotes; Cholinesterase Inhibitors; Drug Overdose; Female; Humans; Male; Physostigmine; Sodium Oxybate

Topics: Drug Overdose; Emergencies; Humans; Physostigmine; Risk Factors; Sodium Oxybate; Treatment Outcome

Topics: Drug Overdose; Emergencies; Humans; Physostigmine; Sodium Oxybate

Topics: Accidents, Traffic; Adult; Brain Injuries; Diagnosis, Differential; Drug Overdose; Emergencies; Female; Humans; Illicit Drugs; Male; Sodium Oxybate

A 20-year-old male patient was brought to the emergency department by Emergency Medical Services after having been found unconscious. Upon arrival the patient was comatose with a GCS of 3, his vital signs were stable (with blood pressure 100/54 mmHg, heart rate 48 per minute, respiration rate 12 per minute and oxygen saturation 98% on room air). Both pupils were 3 mm, symmetric, and only minimally responsive. Approximately 2 hours after arrival the patient awoke and admitted having taken three ampoules of GHB (gamma hydroxybutyrate). GHB is a synthetic analog of gamma-amino butyric acid (GABA), a centrally inhibitory neurotransmitter. While GHB produces euphoria in low doses, small overdosing can result in severe poisoning with coma. The combination with other CNS depressants such as alcohol, opioids, and other narcotics is particularly dangerous. Physicians should be alerted to the clinical effects of GHB since abuse has become more widespread in Switzerland within the last months. In patients with unexplained coma the differential diagnosis of GHB-intoxication should be taken into consideration.

Topics: Adult; Coma; Diagnosis, Differential; Drug Overdose; Emergencies; Humans; Male; Sodium Oxybate

Topics: 4-Butyrolactone; Adjuvants, Anesthesia; Diagnosis, Differential; Drug Overdose; Emergencies; Humans; Mass Spectrometry; Metabolic Clearance Rate; Sodium Oxybate

Topics: Amphetamine; Amphetamine-Related Disorders; Cocaine; Cocaine-Related Disorders; Denmark; Drug Overdose; Hallucinogens; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

In the last months we have seen an increasing number of younger patients admitted to the emergency room in a deep coma, mostly without cardio-pulmonary symptoms. After a few hours they suddenly woke up without any after-effects. Subsequently the patients related that they had taken an unknown drug for recreational purposes and afterwards fell asleep. The patients did not remember anything else about the episode. We believe they had taken gammahydroxybutyrate (GHB). This drug has not previously been described in Danish scientific reports.

Topics: Adult; Central Nervous System Stimulants; Drug Overdose; Humans; Illicit Drugs; Male; Sodium Oxybate; Substance-Related Disorders

To describe the clinical characteristics and course of gamma-hydroxybutyrate (GHB) overdose.. We assembled a retrospective series of all cases of GHB ingestion see in an urban public-hospital emergency department and entered in a computerized database January 1993 through December 1996. From these cases we extracted demographic information, concurrent drug use, vital signs, Glasgow Coma Scale (GCS) score, laboratory values, and clinical course.. Sixty-one (69%) of the 88 patients were male. The mean age was 28 years. Thirty-four cases (39%) involved coingestion of ethanol, and 25 (28%) involved coingestion of another drug, most commonly amphetamines. Twenty-five cases (28%) had a GCS score of 3, and 28 (33%) had scores ranging from 4 through 8. The mean time to regained consciousness from initial presentation among nonintubated patients with an initial GCS of 13 or less was 146 minutes (range, 16-389). Twenty-two patients (31%) had an initial temperature of 35 degrees C or less. Thirty-two (36%) had asymptomatic bradycardia; in 29 of these cases, the initial GCS score was 8 or less. Ten patients (11%) presented with hypotension (systolic blood pressure < or = 90 mm Hg); 6 of these patients also demonstrated concurrent bradycardia. Arterial blood gases were measured in 30 patients; 21 had a PCO2 of 45 or greater, with pH ranging from 7.24 to 7.34, consistent with mild acute respiratory acidosis. Twenty-six patients (30%) had an episode of emesis; in 22 of these cases, the initial GCS was 8 or less.. In our study population, patients who overdosed on GHB presented with a markedly decreased level of consciousness. Coingestion of ethanol or other drugs is common, as are bradycardia, hypothermia, respiratory acidosis, and emesis. Hypotension occurs occasionally. Patients typically regain consciousness spontaneously within 5 hours of the ingestion.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Blood Pressure; Databases, Factual; Drug Overdose; Emergencies; Female; Glasgow Coma Scale; Heart Rate; Humans; Male; Middle Aged; Retrospective Studies; Sodium Oxybate

We describe seven patients presenting with combination substance abuse involving gamma-hydroxybutyric acid (GHB).. During a 3 month period, we identified consecutive patients with GHB ingestion confirmed by urine mass spectrometry presenting to a high-volume urban emergency department.. All patients presented with acute delirium and transient but severe respiratory depression. With supportive care, including intubation and mechanical ventilation in four cases, normal mentation and respiratory function returned within 2 to 6 hours. None of these patients had documented seizures, and none of the four patients who received naloxone had a reversal response. This clinical observation supports previous experimental work in GHB-intoxicated human subjects demonstrating neither epileptiform changes on electroencephalography nor reversal with naloxone. Two findings are remarkable in this series. The first is the observation of a peculiar state of violent aggression present on stimulation of the GHB-intoxicated patient despite near or total apnea. The fact that patients fully recovered from this state may be the result of a previously demonstrated GHB hypoxia-sparing effect. The second is the observation of ECG abnormalities in several cases, including U waves in five patients.. Emergency physicians should be alerted to this agent, its characteristic effects, and its potential for serious sequelae including respiratory arrest and death.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Drug Overdose; Electrocardiography; Emergency Service, Hospital; Female; Gastric Lavage; Humans; Male; Respiration, Artificial; Sodium Oxybate; Substance-Related Disorders

Topics: Coma; Drug and Narcotic Control; Drug Overdose; Humans; Sodium Oxybate; Substance-Related Disorders; United States