sodium-oxybate and Psychomotor-Agitation

The objective of this study was to describe the psychiatric symptoms, management and outcomes in a consecutive series of patients being managed medically for symptoms of withdrawal from gamma-hydroxybutyrate (GHB) and its analogue gamma-butyrolactone (GBL) in a general hospital setting.. A toxicology database was used to identify patients presenting with a history suggestive of withdrawal from GHB and analogues. Electronic and paper medical records were searched for demographic features, neuropsychiatric symptoms, psychiatric management while in hospital and overall outcome.. There were 31 presentations with withdrawal from the drugs involving 20 patients. Of these 17 (54%) were referred to and seen by the liaison psychiatry team. Anxiety (61.3%) and agitation (48.4%) were the most common symptoms. Of the 17 cases seen by the liaison psychiatry team, 52.9% required close constant observation by a mental health nurse and 29.4% required to be detained in hospital under mental health legislation.. The significant proportion of patients presenting with neuropsychiatric symptoms and requiring intensive input from the liaison psychiatry team during withdrawal from GHB and its analogues points to the importance of close liaison between medical and psychiatric teams in managing these patients in the general hospital.

Topics: 4-Butyrolactone; Adult; Anxiety; Disease Management; Emergency Service, Hospital; Female; Hospitals, General; Humans; Male; Mental Health Services; Psychomotor Agitation; Sodium Oxybate; Substance Withdrawal Syndrome; Symptom Assessment

Topics: Adjuvants, Anesthesia; Adult; Akathisia, Drug-Induced; Anesthetics, Intravenous; Central Nervous System Depressants; Confusion; Female; Humans; Psychomotor Agitation; Sodium Oxybate

Topics: Adjuvants, Anesthesia; Adult; Cognitive Behavioral Therapy; Humans; Male; Paroxetine; Phobic Disorders; Psychomotor Agitation; Selective Serotonin Reuptake Inhibitors; Sleep Initiation and Maintenance Disorders; Sodium Oxybate

1,4-Butanediol is an industrial solvent that, when ingested, is converted to gamma-hydroxybutyrate, a drug of abuse with depressant effects, primarily on the central nervous system. After reports of toxic effects of gamma-hydroxybutyrate and its resultant regulation by the federal government, 1,4-butanediol and gamma-butyrolactone, another precursor of gamma-hydroxybutyrate and an industrial solvent, began to be marketed as dietary supplements. We investigated reports of toxic effects due to the ingestion of 1,4-butanediol and reviewed the related health risks.. From June 1999 through December 1999, we identified cases of toxic effects of 1,4-butanediol involving patients who presented to our emergency departments with a clinical syndrome suggesting toxic effects of gamma-hydroxybutyrate and a history of ingesting 1,4-butanediol and patients discovered through public health officials and family members. We used gas chromatography-mass spectrometry to measure 1,4-butanediol or its metabolite, gamma-hydroxybutyrate, in urine, serum, or blood.. We identified nine episodes of toxic effects in eight patients who had ingested 1,4-butanediol recreationally, to enhance bodybuilding, or to treat depression or insomnia. One patient presented twice with toxic effects and had withdrawal symptoms after her second presentation. Clinical findings and adverse events included vomiting, urinary and fecal incontinence, agitation, combativeness, a labile level of consciousness, respiratory depression, and death. No additional intoxicants were identified in six patients, including the two who died. The doses of 1,4-butanediol ingested ranged from 5.4 to 20 g in the patients who died and ranged from 1 to 14 g in the nonfatal cases.. The health risks of 1,4-butanediol are similar to those of its counterparts, gamma-hydroxybutyrate and gamma-butyrolactone. These include acute toxic effects, which may be fatal, and addiction and withdrawal.

Topics: Adult; Butylene Glycols; Dietary Supplements; Fatal Outcome; Female; Humans; Male; Psychomotor Agitation; Pulmonary Edema; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Unconsciousness; Vomiting

Topics: Animals; Carbon Tetrachloride Poisoning; Cats; Diazepam; Drug Evaluation; Drug Evaluation, Preclinical; Drug Therapy, Combination; Hepatic Encephalopathy; Hepatitis, Viral, Human; Humans; Hydroxybutyrates; Necrosis; Psychomotor Agitation; Rabbits; Sodium Oxybate