title: Severe gamma-hydroxybutyrate withdrawal: a case report and literature review.
abstract: We report a case of gamma-hydroxybutyrate (GHB) withdrawal resulting in severe agitation, mental status changes, elevated blood pressure, and tachycardia hours after stopping chronic use of GHB. The patient admitted to substantial GHB abuse on a daily basis for 2.5 years. Previous attempts at cessation reportedly resulted in diaphoresis, tremors, and agitation. The patient's symptoms, negative polypharmacy history, and negative urine and blood toxicological analysis for alcohol, benzodiazepines, sedative-hypnotics, or other substances suggested the diagnosis of GHB withdrawal. Later analysis of a patient drug sample confirmed the presence of GHB. The patient required 507 mg of lorazepam and 120 mg of diazepam over 90 h to control agitation. This is one of the few reported cases of GHB withdrawal and one of the most severe. Given the increasing use of GHB, more cases of severe GHB withdrawal should be anticipated.
authors.affiliation: Department of Emergency Medicine of St. Luke's-Roosevelt Hospital, New York, New York, USA.
authors.forename: K
authors.initials: K
authors.lastname: Craig
authors.forename: H F
authors.initials: HF
authors.lastname: Gomez
authors.forename: J L
authors.initials: JL
authors.lastname: McManus
authors.forename: T C
authors.initials: TC
authors.lastname: Bania
mesh_terms: D000328:Adult; D017109:Akathisia, Drug-Induced / Q000209:etiology; D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D001342:Autonomic Nervous System Diseases / Q000139:chemically induced*; D004630:Emergencies; D018757:GABA Modulators / Q000008:administration & dosage; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D012978:Sodium Oxybate / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000628:therapy; D013610:Tachycardia / Q000139:chemically induced; D014202:Tremor / Q000139:chemically induced*
chemical_list: D014151:Anti-Anxiety Agents; D018757:GABA Modulators; D012978:Sodium Oxybate; D008140:Lorazepam