title: Inpatient Gamma-Hydroxybutyrate Detoxification: A Case Report Describing Day-to-day Therapeutic Management.
abstract: Gamma-hydroxybutyrate (GHB) is a synthetic drug increasingly used by consumers of psychoactive substances. The sought after psychoactive effects of GHB have resulted in an increase in recreational use in Europe. GHB is considered to have a high dependence potential, and abrupt discontinuation after long-term use can result in a severe withdrawal syndrome. Despite a large number of publications related to GHB withdrawal and detoxification, to date, no evidence-based protocol or consensual international therapeutic guidelines are available (over and above the administration of benzodiazepines). We hereby present a day-to-day description of inpatient GHB detoxification management, from admission to discharge.
  
  
  
  This case report pertains to a 47-year-old patient hospitalized for a severe GHB use disorder. The patient had independently made several unsuccessful attempts to stop GHB use. Following to these failures, the patient was oriented to our addiction department for inpatient detoxification. Withdrawal symptoms appeared 4 hours after the last dose of GHB, and consisted of diaphoresis, coenesthetic hallucinations, tremors, motor instability, tachycardia, and a hypertensive peak. Symptoms were successfully managed with diazepam titration and nonpharmacological treatment. The duration of hospitalization was 13 days. At discharge, detoxification was complete and the patient was engaged in relapse prevention therapy. Three months after discharge, the patient had maintained abstinence.
  
  
  
  GHB withdrawal, which can be severe, is better prevented or attenuated by daily medical monitoring and adjustment of treatment dosage. Failure of outpatient detoxification should be included in the indication criteria in the guidelines for inpatient detoxification.
authors.affiliation: Addictology and Psychiatry Department, Nantes University Hospital, France (LvT, MR, JC, HD, MGB); Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France (MR, CVV); EA 4275, Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, Nantes University, France (MR, JC, CVV, MGB); Poison Control Center, University Hospital, Angers, France (DB).
authors.forename: Louis
authors.initials: L
authors.lastname: von Theobald
authors.forename: Morgane
authors.initials: M
authors.lastname: Rousselet
authors.forename: Jennyfer
authors.initials: J
authors.lastname: Cholet
authors.forename: Hélène
authors.initials: H
authors.lastname: Debar
authors.forename: David
authors.initials: D
authors.lastname: Boels
authors.forename: Caroline
authors.initials: C
authors.lastname: Victorri-Vigneau
authors.forename: Marie
authors.initials: M
authors.lastname: Grall-Bronnec
mesh_terms: D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012978:Sodium Oxybate / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000628:therapy; D019966:Substance-Related Disorders / Q000628:therapy*
chemical_list: D012978:Sodium Oxybate