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GHB Withdrawal

Aka: GHB Withdrawal, Gamma Hydroxybutyrate Withdrawal
  1. See Also
    1. Gamma Hydroxybutyrate
    2. Chemical Dependency
    3. Drug Withdrawal
  2. 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)
  3. 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
  4. Differential Diagnosis
    1. Other Sedative-Hypnotic Use
    2. Alcohol Withdrawal
    3. SympathomimeticIntoxication
    4. Serotonin Syndrome
    5. Neuroleptic Malignant Syndrome
    6. Thiamine deficiency
    7. Thyrotoxicosis
    8. Pheochromocytoma
    9. Steroid Psychosis
  5. Labs
    1. See Gamma Hydroxybutyrate
  6. 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)
  7. References
    1. Masom and Tomaszewski (2018) Crit Dec Emerg Med 32(11): 23
    2. Dyer (2001) Ann Emerg Med 37(2):147-52 [PubMed]

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