II. Preparations
- Active Drug (DEA Schedule 1 Drug)
- Gamma Hydroxybutyrate
- Precursor Drugs (abused drugs that metabolize to GHB)
- 1,4-Butanedial (BD)
- Gamma-Butyrolactone (GBL)
- Street Names
- G
- Liquid E
- Liquid Ecstasy
- Liquid X
- Grievous Bodily Harm
- Easy Lay
- Cherry Meth
- Georgia Home Boy
III. Indications: No Medical Indications
- Illicit Uses
- Date Rape for sedation and incapacitation
- Recreational drug and Club Drug for sedation and euphoria
- Anabolic Steroid alternative in bodybuilding (for Growth Hormone secretion)
- Previous Medical Uses
- Surgical Anesthetic in Europe (1960 in France)
- Induce short term coma
- Narcolepsy (Sodium oxybate)
- Alcohol Withdrawal (Sodium oxybate)
- Opiate dependency
- Classified as a Schedule I Controlled Substance
- Non-prescription use banned in 1990 in U.S.
IV. Pharmacology
- Mechanism
- Derivative of gamma aminobutyric acid (GABA)
- Agonist at GABA B Receptors
- Characteristics
- Colorless, odorless liquid
- Salty Taste
- Pharmacokinetics
- Onset of effect within 15 to 30 minutes
- Peak activity at 20 to 60 minutes
- Half-life: 20-50 minutes
- Effect decreases after 3-4 hours
V. Findings: Symptoms and Signs
- Early
- Euphoria
- Later
- Dizziness
- Drowsiness or Somnolence
- Sialorrhea
- Hypotonia
- Vomiting
- Amnesia or Memory Loss
- Pupil Changes (Miosis or Mydriasis)
- Overdose
VI. Adverse Effects (see above)
- High risk of Overdose (dose often unknown)
- Sixty deaths from GHB in 2000 due to Overdose
- Bradycardia
- Hypotension
- Hypothermia
- Respiratory depression or apnea
- Altered Level of Consciousness
- Seizure-like activity
- Coma
VII. Drug Interactions
- May be lethal in combination with drugs or Alcohol
VIII. Labs: GHB
- Detected by urine or Blood Gas chromatography
- Requires special testing by sensitive instrument
- Measurable only for 6-12 hours after ingestion
- Quickly excreted into urine
- Often cleared with first void
IX. Labs: Other
- See Unknown Ingestion
- Bedside Glucose
- Other Toxicology Screening (for other agents)
- Blood Alcohol level
- Acetaminophen Level
- Salicylate Level
- Urine Drug Screening
X. Management
- GHB Intoxication
- Supportive care including airway management
- Intravenous Fluids
- Avoid Gastric Decontamination
- Unlikely benefit (GHB is rapidly absorbed) and risk of aspiration
- Consider Endotracheal Intubation
- Short-half life of hours (self-Extubation is common)
- Withdrawal Syndrome from frequent large dose GHB use
- See GHB Withdrawal
XI. References
- Galloway (1996) News of Cal Soc Addict Med 23(1):1
- Masom and Tomaszewski (2018) Crit Dec Emerg Med 32(11): 23
- Dyer (2001) Ann Emerg Med 37(2):147-52 [PubMed]
- Gahlinger (2004) Am Fam Physician 69:2619-27 [PubMed]
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Related Studies
| Definition (MSH) | One of the FURANS with a carbonyl thereby forming a cyclic lactone. It is an endogenous compound made from gamma-aminobutyrate and is the precursor of gamma-hydroxybutyrate. It is also used as a pharmacological agent and solvent. |
| Concepts | Pharmacologic Substance (T121) , Biologically Active Substance (T123) , Indicator, Reagent, or Diagnostic Aid (T130) , Organic Chemical (T109) |
| MSH | D015107 |
| English | 1,4 Butanolide, 1,4-Butanolide, 4 Butyrolactone, 4 Hydroxybutyric Acid Lactone, 4-Butyrolactone, 4-Hydroxybutyric Acid Lactone, gamma Butyrolactone, gamma-Butyrolactone, Lactone, 4-Hydroxybutyric Acid, 2(3H)-Furanone, dihydro-, BUTYROLACTONE 04, HYDROXYBUTYRIC ACID LACTONE 04, BUTANOLIDE 01 04, 4-Butyrolactone [Chemical/Ingredient], gamma-butyrolactone, gamma butyrolactone, Dihydro-2(3H)-furanone, Furanone, tetrahydro 2, Furanone, tetrahydro-2- |
| Swedish | 4-butyrolakton |
| Czech | 4-butyrolakton |
| Finnish | 4-butyrolaktoni |
| Russian | 1,4-BUTANOLID, GAMMA-BUTIROLAKTON, 4-GIDROKSIMASLIANOI KISLOTY LAKTON, 4-BUTIROLAKTON, 1,4-БУТАНОЛИД, 4-БУТИРОЛАКТОН, 4-ГИДРОКСИМАСЛЯНОЙ КИСЛОТЫ ЛАКТОН, ГАММА-БУТИРОЛАКТОН |
| Japanese | ガンマ-ブチロラクトン, 1,4-ブタノリド, 4-ヒドロキシ酪酸ラクトン, 4-ブチロラクトン, ガンマブチロラクトン, γ-ブチロラクトン |
| German | BUTYROLACTON 04, DIHYDRO FURANON 02 03, HYDROXYBUTTERSÄURE LACTON 04, BUTANOLID 01 04, 1,4-Butanolid, 4-Butyrolacton, Gamma-Butyrolacton, Dihydro-2(3H)-furanon, Furanon, tetrahydro-2-, 4-Hydroxybuttersäure-Lacton |
| Spanish | Tetrahidro-2-Furanona, 1,4-Butanolida, 4-Butirolactona, gammabutirolactona, Ácido 4-Hidroxibutirico de Lactona |
| Polish | 4-butyrolakton |
| French | Tétrahydro-furan-2-one, Tétrahydrofuran-2-one, gamma-Butyrolactone, 4-Butyrolactone |
| Portuguese | Tetra-Hidro-2-Furanona, Tetraidro-2-Furanona, 1,4-Butanolídeo, 4-Butirolactona, gama-Butirolactona, Lactona do Ácido 4-Hidroxibutírico |
| Italian | 4-butirolattone |
Ontology: gamma hydroxybutyrate (C0000503)
| Definition (CSP) | hydroxy derivative of butyric acid substituted at the gamma, or 4 position; intermediate in the metabolism of gamma-aminobutyric acid (GABA). |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D012978 |
| SnomedCT | 259470008, 102645005, 386029006 |
| LNC | LP28491-6, MTHU013043 |
| English | gamma hydroxybutyrate, Gamma hydroxybutyrate, gamma-hydroxybutyrate, 4-hydroxybutyrate, ghb, gamma-Hydroxybutyrate (substance), 4-Hydroxybutanoate, Gamma-hydroxybutyrate, gamma Hydroxybutyrate, 4-Hydroxybutyrate, GHB, 4-Hydroxybutyrate (substance), gamma-Hydroxybutyrate |
| Portuguese | gama-Hidroxibutirato |
| Spanish | gammahidroxibutirato, gamma-hidroxibutirato, 4 - hidroxibutirato, gamma - hidroxibutirato (sustancia), 4 - hidroxibutanato, gamma - hidroxibutirato, 4-hidroxibutirato (sustancia), 4-hidroxibutirato |
| German | Gamma-Hydroxybutyrat |
| French | gamma-Hydroxybutyrate, 4-Hydroxybutyrate, 4-Hydroxy-butyrate, gamma-Hydroxy-butyrate |
