title: Clinical features of gamma-hydroxybutyrate and gamma-butyrolactone toxicity and concomitant drug and alcohol use.
abstract: OBJECTIVE
  To describe the clinical features of gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) toxicity.
  
  
  METHODS
  Retrospective case-study of 65 GHB and GBL intoxications seen in an urban emergency department.
  
  
  RESULTS
  63% of intoxications occurred in male patients. The median age was 24 years (range 16-41 years). 65% co-ingested alcohol or illicit drugs, mostly MDMA and cocaine. 83% presented with coma. The mean+/-S.D. time to regain consciousness among comatose patients was 111+/-61 min and was significantly longer in patients who co-abused illicit drugs such as cocaine or MDMA (155+/-60 min). Bradycardia occurred in 38%, hypotension in 6% and hypothermia in 48%. Agitation was observed in 17% of all patients and was significantly more frequent in patients with alcohol co-use (29%). Vomiting occurred in 31% of all patients and tended to be more frequent in patients who co-used alcohol (39%). Management of GHB and GBL overdose was supportive. Four patients needed admission to an intensive care unit for mechanical ventilation (6%).
  
  
  CONCLUSIONS
  Overdosing of GHB and GBL frequently results in non-reactive coma reflecting the severity of poisoning. Multiple drug use is common and significantly influences the clinical presentation.
authors.affiliation: Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland. meliechti@dplanet.ch
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Liechti
authors.forename: Isabelle
authors.initials: I
authors.lastname: Kunz
authors.forename: Peter
authors.initials: P
authors.lastname: Greminger
authors.forename: Rudolf
authors.initials: R
authors.lastname: Speich
authors.forename: Hugo
authors.initials: H
authors.lastname: Kupferschmidt
mesh_terms: D015107:4-Butyrolactone / Q000009:adverse effects / Q000633:toxicity*; D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D018686:Anesthetics, Intravenous / Q000633:toxicity*; D001919:Bradycardia / Q000139:chemically induced / Q000453:epidemiology; D016022:Case-Control Studies; D003128:Coma / Q000139:chemically induced / Q000453:epidemiology; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D012189:Retrospective Studies; D012978:Sodium Oxybate / Q000633:toxicity*; D012997:Solvents / Q000009:adverse effects / Q000633:toxicity*
chemical_list: D018686:Anesthetics, Intravenous; D012997:Solvents; D012978:Sodium Oxybate; D015107:4-Butyrolactone