GHB Withdrawal

Aka: GHB Withdrawal, Gamma Hydroxybutyrate Withdrawal

II. Pathophysiology

  1. GHB Dependence is rare due to rapid elimination
  2. GHB Dependence may occur with excessive use
    1. Frequent dosing (q1-3 hours around the clock)
    2. Chronic use

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
  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 restraints
    1. Four point Physical Restraints
    2. See also Chemical Restraints
  2. Symptomatic management
  3. Sedation
    1. Benzodiazepine
    2. Barbiturate

VII. References

  1. Dyer (2001) Ann Emerg Med 37(2):147-52 [PubMed]

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