Gamma Hydroxybutyrate

Aka: Gamma Hydroxybutyrate, Gamma-Hydroxybutyrate, 1,4-Butanedial, Gamma-Butyrolactone, GHB

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II. Preparations

  1. Active Drug (DEA Schedule 1 Drug)
    1. Gamma Hydroxybutyrate
  2. Precursor Drugs (abused drugs that metabolize to GHB)
    1. 1,4-Butanedial (BD)
    2. Gamma-Butyrolactone (GBL)
  3. Street Names
    1. G
    2. Liquid E
    3. Liquid Ecstasy
    4. Liquid X
    5. Grievous Bodily Harm
    6. Easy Lay
    7. Cherry Meth
    8. Georgia Home Boy

III. Indications: No Medical Indications

  1. Illicit Uses
    1. Date Rape for sedation and incapacitation
    2. Recreational drug and Club Drug for sedation and euphoria
    3. Anabolic Steroid alternative in bodybuilding (for Growth Hormone secretion)
  2. Previous Medical Uses
    1. Surgical Anesthetic in Europe (1960 in France)
    2. Induce short term coma
    3. Narcolepsy (Sodium oxybate)
    4. Alcohol Withdrawal (Sodium oxybate)
    5. Opiate dependency
    6. Classified as a Schedule I Controlled Substance
      1. Non-prescription use banned in 1990 in U.S.

IV. Pharmacology

  1. Mechanism
    1. Derivative of Gamma Aminobutyric Acid (GABA)
    2. Agonist at GABA B Receptors
  2. Characteristics
    1. Colorless, odorless liquid
    2. Salty Taste
  3. Pharmacokinetics
    1. Onset of effect within 15 to 30 minutes
    2. Peak activity at 20 to 60 minutes
    3. Half-Life: 20-50 minutes
    4. Effect decreases after 3-4 hours

V. Findings: Symptoms and Signs

  1. Early
    1. Euphoria
  2. Later
    1. Dizziness
    2. Drowsiness or Somnolence
    3. Sialorrhea
    4. Hypotonia
    5. Vomiting
    6. Amnesia or Memory Loss
    7. Pupil Changes (Miosis or Mydriasis)
  3. Overdose
    1. Cheyne-Stokes Respiration
    2. Seizures or Myoclonus
    3. Coma

VI. Adverse Effects (see above)

  1. High risk of Overdose (dose often unknown)
    1. Sixty deaths from GHB in 2000 due to Overdose
  2. Bradycardia
  3. Hypotension
  4. Hypothermia
  5. Respiratory depression or apnea
  6. Altered Level of Consciousness
  7. Seizure-like activity
  8. Coma

VII. Drug Interactions

  1. May be lethal in combination with drugs or Alcohol

VIII. Labs: GHB

  1. Detected by urine or Blood Gas chromatography
    1. Requires special testing by sensitive instrument
  2. Measurable only for 6-12 hours after ingestion
    1. Quickly excreted into urine
    2. Often cleared with first void

IX. Labs: Other

  1. See Unknown Ingestion
  2. Bedside Glucose
  3. Other Toxicology Screening (for other agents)
    1. Blood Alcohol Level
    2. Acetaminophen Level
    3. Salicylate Level
    4. Urine Drug Screening

X. Management

  1. GHB Intoxication
    1. Supportive care including airway management
    2. Intravenous Fluids
    3. Avoid Gastric Decontamination
      1. Unlikely benefit (GHB is rapidly absorbed) and risk of aspiration
    4. Consider Endotracheal Intubation
      1. Short-half life of hours (self-Extubation is common)
  2. Withdrawal Syndrome from frequent large dose GHB use
    1. See GHB Withdrawal

XI. References

  1. Galloway (1996) News of Cal Soc Addict Med 23(1):1
  2. Masom and Tomaszewski (2018) Crit Dec Emerg Med 32(11): 23
  3. Dyer (2001) Ann Emerg Med 37(2):147-52 [PubMed]
  4. Gahlinger (2004) Am Fam Physician 69:2619-27 [PubMed]

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