title: ["Liquid ecstasy": gamma-butyrolactone withdrawal delirium with rhabdomyolysis and dialysis dependent renal failure].
abstract: METHODS
  A 24-year-old man with known abuse of gamma-butyrolactone (GBL) was found with stupor and myoclonies on all extremities. He had been known to have ingested 2 ml of pure GBL every half an hour. Decubiti were detected on the knuckle of the right foot, on both elbows and at the rump.
  
  
  METHODS
  Laboratory findings revealed signs of severe rhabdomyolysis and renal failure as well as elevated markers of inflammation. Other routine laboratory parameters were normal. A toxicological screening revealed no signs of an acute intoxication.
  
  
  METHODS
  A GBL withdrawal syndrome was diagnosed. The treatment of agitation and myoclonies required repeated applications of benzodiazepines. Because of the resulting respiratory depression the patient had to be intubated. To cope with myoclonies and other symptoms of substance withdrawal we had to administer midazolame and clonidine continuously until day four. Because of acute renal failure resulting from rhabdomyolysis hemodialysis was necessary three times. After 19 days the patient was transferred to a psychiatric clinic.
  
  
  CONCLUSIONS
  Primary care physicians treating patients with a coma of unknown cause always have to think of the possibility of GBL withdrawal. The treatment will be symptomatic.
authors.affiliation: Medizin III - Kardiologie und Angiologie Universitätsklinikum Freiburg. Alexander.Supady@uniklinik-freiburg.de
authors.forename: A
authors.initials: A
authors.lastname: Supady
authors.forename: T
authors.initials: T
authors.lastname: Schwab
authors.forename: H-J
authors.initials: HJ
authors.lastname: Busch
mesh_terms: D015107:4-Butyrolactone / Q000009:adverse effects*; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D001569:Benzodiazepines / Q000008:administration & dosage; D003000:Clonidine / Q000008:administration & dosage; D018757:GABA Modulators / Q000008:administration & dosage; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D009207:Myoclonus / Q000139:chemically induced / Q000188:drug therapy; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000188:drug therapy; D012997:Solvents / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000628:therapy; D055815:Young Adult
chemical_list: D000316:Adrenergic alpha-Agonists; D018757:GABA Modulators; D012997:Solvents; D001569:Benzodiazepines; D003000:Clonidine; D015107:4-Butyrolactone; D008874:Midazolam