Mental Health Book

Hallucinogen Use Disorders




Gamma Hydroxybutyrate

Aka: Gamma Hydroxybutyrate, Gamma Hydroxybutyrate, 1,4-Butanedial, Gamma-Butyrolactone, GHB
  1. See Also
    1. Chemical Dependency
    2. Substance Abuse Evaluation
  2. 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
  3. 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.
  4. 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
  5. 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
  6. 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
  7. Drug Interactions
    1. May be lethal in combination with drugs or Alcohol
  8. 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
  9. 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
  10. 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
  11. 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]

4-Butyrolactone (C0000481)

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
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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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