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Always check local toxicology guidelines or consult the National Poisons Information Service (NPIS). GHB is sometimes called a “date rape drug” because it can be slipped into drinks and causes rapid sedation and amnesia. Safeguarding and forensic considerations are vital.
📖 About
- Gamma Hydroxybutyrate (GHB) toxicity results from overdose of GHB or its pro-drugs (GBL, 1,4-butanediol).
- Usually encountered as a colourless, odourless liquid, sometimes sold as a white powder.
- Used recreationally for its euphoriant and sedative effects; also misused in gyms for alleged growth hormone stimulation.
- Onset is rapid (within 15–30 min) and offset is abrupt, leading to sudden swings from coma to wakefulness.
🧠 Clinical Features
- Early: mild euphoria, disinhibition, agitation.
- Neurological: sedation, amnesia, confusion, myoclonic jerks, seizures.
- Pupils: miosis is common but not universal.
- Severe: bradycardia, hypotension, profound CNS depression, respiratory arrest, coma. Episodes of sudden arousal can occur.
- Interactions: effects potentiated by alcohol, benzodiazepines, and opioids.
- Most patients recover spontaneously in 2–6 h if well supported.
🔍 Investigations
- Routine bloods: FBC, U&E, LFTs, glucose, electrolytes (hypokalaemia possible).
- VBG/ABG: may reveal metabolic acidosis if severe.
- Toxicology: Standard hospital drug screens do not detect GHB. Specialised forensic testing may be required if sexual assault suspected.
💊 Management
- Airway, Breathing, Circulation (ABCs): airway support is crucial; provide O₂, intubate if apnoeic or GCS <8.
- Monitoring: continuous observation in resus or ITU for comatose patients - sudden recovery is possible.
- Supportive care only: there is no antidote. Naloxone and flumazenil are ineffective.
- Activated charcoal: generally not useful, as absorption is very rapid. Consider only if very early and airway secure.
- Observation: at least 6 h. Admit to ITU if recurrent apnoea, severe bradycardia, or refractory hypotension.
- Safeguarding: in suspected surreptitious administration, early forensic samples and safeguarding referral are essential.
