title: Verve and Jolt: deadly new Internet drugs.
abstract: As regulatory agencies have increased restrictions on the sale and marketing of gamma-hydroxybutyrate (GHB), they have been frustrated by the appearance of precursor molecules such as gamma-butyrolactone (GBL) that have become widely available over the Internet. These dangerous precursors are vigorously marketed to adolescents and young adults as dietary supplements that increase muscle mass and enhance sexual performance with seductive names such as Verve and Jolt, both easily recognizable teen icons. We present the case of an adolescent who ingested both of these GBL products 2 weeks apart, resulting in life-threatening respiratory depression and emergent intubation on both occasions. The GBL toxidrome, necessary acute interventions, and public health implications are reviewed. We urge all health care providers to report similar cases immediately to the FDA MedWatch system. Gamma-butyrolactone, gamma-hydroxybutyrate, respiratory insufficiency, central nervous system depressants, substance abuse.
authors.affiliation: Department of Pediatrics, Boston Medical Center and Boston University Medical School, Children's Hospital Boston and Harvard Medical School Boston, MA 02115, USA. jwinickoff@yahoo.com
authors.forename: J P
authors.initials: JP
authors.lastname: Winickoff
authors.forename: C S
authors.initials: CS
authors.lastname: Houck
authors.forename: E L
authors.initials: EL
authors.lastname: Rothman
authors.forename: H
authors.initials: H
authors.lastname: Bauchner
mesh_terms: D015107:4-Butyrolactone / Q000009:adverse effects*; D000293:Adolescent; D000329:Advertising; D005260:Female; D006801:Humans; D020407:Internet; D011355:Prodrugs / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D012997:Solvents / Q000009:adverse effects*
chemical_list: D011355:Prodrugs; D012997:Solvents; D015107:4-Butyrolactone