title: A case of withdrawal from the GHB precursors gamma-butyrolactone and 1,4-butanediol.
abstract: We describe a case of withdrawal from the gamma hydroxybutyric acid (GHB) precursors gamma butyrolactone and 1,4-butanediol. Symptoms included visual hallucinations, tachycardia, tremor, nystagmus, and diaphoresis. Administration of benzodiazepines and phenobarbital successfully treated the withdrawal symptoms. As predicted from the metabolism of gamma butyrolactone and 1,4-butanediol to GHB, the symptoms were nearly identical to those reported from GHB withdrawal. Because GHB is now illegal in the United States, individuals have begun abusing the legal and easier to acquire GHB precursors. More frequent cases of both abuse and withdrawal from these GHB precursors can be expected.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, UCSD Medical Center, California Poison Control System-San Diego Division, 200 West Arbor Drive, San Diego, CA 92103-8925, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Schneir
authors.forename: B T
authors.initials: BT
authors.lastname: Ly
authors.forename: R F
authors.initials: RF
authors.lastname: Clark
mesh_terms: D015107:4-Butyrolactone / Q000009:adverse effects*; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D003975:Diazepam / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004630:Emergencies; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D010634:Phenobarbital / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy / Q000209:etiology*; D014481:United States
chemical_list: D000927:Anticonvulsants; D008140:Lorazepam; D015107:4-Butyrolactone; D003975:Diazepam; D010634:Phenobarbital