Characteristics and dose-effect relationship of clinical gamma-hydroxybutyrate intoxication: A case series.

Gamma-Hydroxybutyrate (GHB) overdoses cause respiratory depression, coma, or even death. Symptoms and severity of poisoning depend on blood-concentrations and individual factors such as tolerance. A retrospective case study was conducted, evaluating GHB intoxication cases. GHB-concentrations in blood and urine were determined by gas chromatography-mass spectrometry (GC-MS) along with, in part, via enzymatic assay. GHB-concentrations, demographic data, and additional drug use, as well as specific clinical information, were evaluated. The correlation between GHB-levels in blood and associated symptoms were examined. In total, 75 cases originating from the Emergency Departments (EDs) of Hamburg and surrounding hospitals were included. Fifty-four of the patients (72%) were male. The mean GHB-concentration in blood was 248 mg/L (range 21.5-1418 mg/L). Out of the group with detailed clinical information (n = 18), the comatose group (n = 10/18) showed a mean of 244 mg/L (range 136-403 mg/L), which was higher than that of the somnolent and awake patients. Of the comatose collective, 70% (n = 7) showed co-use of one or more substances, with the additional use of cocaine being the most frequently detected (n = 5). In conclusion, a moderate dose-effect relationship was observed, although, there was some overlap in dosage concentration levels of GHB in awake and comatose patients. In GHB-intoxication cases, co-use was common as were clinical effects such as acidosis, hypotension, and impact on the heart rate. Timely analytical determination of the GHB-concentration in blood could support correct diagnosis of the cause of unconsciousness.

Liquid ecstasy - a significant drug problem.

INTRODUCTION: Gamma-hydroxybutyric acid (GHB, "liquid ecstasy") and its legal pro-drugs gamma-butyrolactone and 1,4-butanediol are gaining in importance as recreational drugs in Germany. The effects of these substances are comparable with those of alcohol or benzodiazepines. Because of the wide availability of GHB physicians are increasingly being confronted with cases of intoxication. METHODS: This review is based on a selective literature search as well as on the authors' own experience and on information provided by the GIZ-Nord Poisons Centre, Göttingen, Germany. RESULTS: Consumption of a high dose of GHB or its prodrugs leads to severe intoxication with respiratory depression and coma. Only supportive therapy can be offered; no antidote is available. DISCUSSION: In any patient with impaired consciousness of unknown cause, the possibility of intoxication with GHB must be considered. Chemical detection of GHB in blood or urine is possible only using specific analytical methods and only within a short time frame (<12 h). Because of the short half-life of GHB, intoxications treated in intensive care units rarely show any complications. However, a number of fatalities have occurred. The potential abuse of GHB as a date rape drug must be borne in mind.