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