Off it! Part 3: GHB

GammaHydroxybutyric Acidghb

[ – Mental model: – Benzos,  ‘DOWN’]

Legal Status:  Class C

Think of GHB as a possibility in patients who are often male, body building and appear ‘drunk’.  GHB patients get VERY flat, very quickly if they get the dose wrong, and alcohol potentiates this.

Other signs of acute toxicity – LOW RR, GCS, BP and Hypersalivation

They are really hard to wake up (no matter what ‘trick’ you use).

GHB binds to GABA and inhibits the release of action potentials from the synapse.  In high enough concentrations GHB gets converted to GABA.  You may hear that someone has taken GBL (or gamma butyrolactone) that’s the precursor and has a delayed affect, especially when take with alcohol.

It seems to be used in social circles of gym fanatics.  There is a belief that it increases human growth hormone release, and improves muscle repair, AND is a calorie free way of getting the buzz people want from alcohol.  It’s also been used as a date rape drug.

Management

Supportive.

These patients sometimes require airway protection.  They will wake up on ICU the next day, thank no one, and leave.   Deaths occur when patients lose their airway control outside of hospital.

Withdrawl

Some people take GHB a lot, if they get their recreational dosing correct can re-dose, and re-dose night after night (or regularly for work outs), when their supply runs out, or changes they can get a rebound effect which is like an alcohol withdrawl, symptoms start 6 hours after the last dose.  It can last much longer (weeks), and is more resistant to benozodiazepines.

The autonomic features are present, but slightly reduced, however the syndrome can last longer (up to two weeks).  Control it with benzodiazepines and baclofen (GABA agonists), and titrate down slowly like with alcohol withdrawl.

Early features – insomnia, tremor, confusion, nausea and vomiting

Late features – tachycardia, hypertension, agitation, seizures and/or myoclonic jerks and hallucinations

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