GHB Withdrawal

Aka: GHB Withdrawal, Gamma Hydroxybutyrate Withdrawal

advertisement

II. Pathophysiology

  1. GHB Dependence is rare due to rapid elimination
  2. GHB Dependence may occur with excessive use
    1. Chronic use (common in bodybuilders)
    2. Frequent dosing (evert 1-3 hours around the clock)

III. Symptoms: Withdrawal

  1. Early symptoms
    1. Insomnia
    2. Tremor
    3. Anxiety
    4. Confusion
    5. Nausea and Vomiting
  2. Later symptoms
    1. Agitation
    2. Vivid Hallucinations
    3. Combative behavior
    4. Disorientation
    5. Seizures
  3. Associated Symptoms: Autonomic Instability
    1. Tachycardia
    2. Hypertension
    3. Tremor
    4. Diaphoresis

IV. Differential Diagnosis

  1. Other Sedative-Hypnotic Use
  2. Alcohol Withdrawal
  3. Sympathomimetic Intoxication
  4. Serotonin Syndrome
  5. Neuroleptic Malignant Syndrome
  6. Thiamine deficiency
  7. Thyrotoxicosis
  8. Pheochromocytoma
  9. Steroid Psychosis

V. Labs

  1. See Gamma Hydroxybutyrate

VI. Management

  1. Agitation may require initial restraints (Agitated Delirium)
    1. Four point Physical Restraints may be needed initially
    2. Treat with sedation agents below
    3. See Chemical Restraints
  2. Sedation
    1. Benzodiazepine
    2. Barbiturate
  3. Other symptomatic management
    1. Consider other GABA-B Agonists (e.g. Baclofen)

VII. References

  1. Masom and Tomaszewski (2018) Crit Dec Emerg Med 32(11): 23
  2. Dyer (2001) Ann Emerg Med 37(2):147-52 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "GHB Withdrawal." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Related Topics in Chemical Dependency

advertisement