October 7, 2011 by dailybolusoflr
GHB or Gamma-hydroxybutyrate
· GHB initially came onto the scene as a diet fad which was popular among body builders. It was used under the theory that it released growth hormone and helped to burn fat into muscle while you slept.
· GHB has now become a drug of abuse on the street, taken voluntarily as well as used as a “date-rape” drug.
· The mechanism of action involves increasing dopamine levels and endogenous opioid levels. GHB is also a catabolite of GABA- the primary inhibitory neurotransmitter in the brain.
· Typical patient presentation includes a patient with relatively stable vital signs (HR and BP) who has significantly decreased mental status to the point of obtundation. Concomitant ingestion of alcohol or other sedative-hypnotic drugs are more likely to lead to respiratory depression and hypotension in the presentation, but even without co-ingestants, patients can have significant respiratory depression to the point of requiring intubation.
· The hallmark of this ingestion is the rapid recovery to a completely normal mental state without anything other than supportive care. Care should be taken to prevent self-harm in these patients (from self-extubation upon awakening or other possible agitated behavior that can injure the patient) as they can often have a period of hyper-arousal when they awake. Consideration to the use of restraints in these patients with high suspicion of GHB intoxication should occur.
· Given the increase in endogenous opioid levels, use of naloxone has been suggested. Results are inconsistent and so use in these patients is still controversial.
Ref: Goldfrank’s Toxicology