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GHB Poisoning, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Naturally occurring analog of γ-aminobutyric acid (GABA)

  • Used medically for narcolepsy

  • Nonmedical uses:

    • Bodybuilding agent

    • Euphoric agent

    • Date-rape/predatory agent

  • γ-Hydroxybutyrate (GHB) ...

Diagnosis

Signs and Symptoms

  • CNS:

    • CNS depression

    • Ataxia/dizziness

    • Impaired judgment

    • Aggressive behavior

    • Clonic movements of the extremities

    • Coma

    • Seizures

  • Pulmonary:

    • Respiratory depression

    • Apnea

    • Laryngospasm (rare...

Treatment

Pre-Hospital

Transport all pills/bottles and drug paraphernalia involved in overdose for identification in ED. 

Initial Stabilization/Therapy

  • ABCs:

    • Airway control essential

    • Administer supplementa...

Follow-Up

Disposition

Admission Criteria

  • Intubated patient

  • Patient with hypothermia or other hemodynamic instability

  • Coingestion prolonging duration of intoxication

Discharge Criteria

  • Asymptomatic after 6 h...

Pearls and Pitfalls

  • Consider nontoxicologic causes for persistent altered mental status

  • Routine hospital drug testing will not confirm GHB or other common recreational drugs of abuse

Additional Reading

  • Gahlinger  PM. Club drugs: MDMA, gamma-hydroxybutyrate (GHB), Rohypnol, and ketamine. Am Fam Physician.  2004;69(11):2619–2926.

  • Schep  LJ, Knudsen  K, Slaughter  RJ, et al. The ...

Codes

ICD9

968.4 Poisoning by other and unspecified general anesthetics 

ICD10

  • T41.291A Poisoning by oth general anesthetics, accidental, init

  • T41.293A Poisoning by other general anesthetics, assault, ini...

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