title: Extreme γ-butyrolactone overdose with severe metabolic acidosis requiring hemodialysis.
abstract: γ-Hydroxybutyrate (GHB) and its precursor γ-butyrolactone (GBL) are commonly abused drugs with a narrow therapeutic index. Therefore, overdoses occur readily with recreational use, and severe poisoning can occur after deliberate self-poisoning. We report the sequelae in a patient who ingested a massive dose of GBL, with suicidal intent. Severe metabolic acidosis and an asystolic cardiac arrest were successfully treated with standard resuscitation, supportive care, and continuous venovenous hemodiafiltration. Plasma GHB concentrations were the highest reported to date. The acidosis was attributed to rapid systemic absorption of GBL, followed by rapid metabolism to GHB.
authors: Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia. 1darren1@gmail.com
authors: Darren M
authors: DM
authors: Roberts
authors: Myles W H
authors: MW
authors: Smith
authors: Manivannan
authors: M
authors: Gopalakrishnan
authors: Geoffrey
authors: G
authors: Whittaker
authors: Richard O
authors: RO
authors: Day
mesh_terms: D015107:4-Butyrolactone / Q000097:blood / Q000506:poisoning*; D000138:Acidosis / Q000139:chemically induced* / Q000628:therapy; D000328:Adult; D062787:Drug Overdose; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D008297:Male; D006435:Renal Dialysis; D013406:Suicide, Attempted
chemical_list: D015107:4-Butyrolactone