DESCRIPTION
USES
This substance is used either industrially or therapeutically, but can be subject to abuse.
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Treatment for narcolepsy Treatment for alcoholism Anesthetic agent Euphoric “Date rape” agent “Growth Hormone booster” “Aphrodisiac” “Muscle builder” (although effectiveness has never been proven) |
INTERVENTION CRITERIA
The correct identification of the substance is important. If the symptoms are inconsistent with those described, or the history is considered unreliable, other substances may need to be considered. |
Medical observation is recommended: For any suspected exposure in children The risks of decontamination outweigh any benefits, and should not be attempted. |
Medical observation is recommended: For any suspected ingestion The risks of decontamination outweigh any benefits, and should not be attempted. History of dose ingested is not a reliable guide to management. |
All patients require medical attention. |
If medical observation is required the patient must be monitored for 6 hours following exposure for onset or worsening of symptoms. |
If the patient is asymptomatic at the end of the observation period, and if they have been appropriately decontaminated and any investigations have been carried out, they may be: Discharged into the care of a reliable observer, or Referred for psychological assessment if the overdose was with intent of self-harm. |
Serum levels do not aid management. |
Monitor: Level of consciousness Heart rate Blood pressure Respirations Seizure activity |
Hospital admission is recommended with: Any symptomatic ingestion |
The admission hospital may require the following resources: Advanced care facilities/Intensive Care Unit |
TREATMENT
TREATMENT SUMMARY
Due to this drug's fast onset of action, gastrointestinal decontamination is not recommended. Airways management is the mainstay of treatment and with adequate supportive care the prognosis is good. Intubation, and possibly ventilation, may be necessary due to respiratory depression and aspiration risk. Profound coma is a well recognized consequence following ingestion of this compound and is generally short-term. While wakening may be hastened with use of physostigmine (an experimental antidote for this indication), patients will generally satisfactorily recover with adequate airways management alone. Seizures may rarely occur and, in the presence of coma, indicate anoxia: manage the airway and ensure adequate ventilation. Should repetitive seizure occur in a well ventilated patient treat with a benzodiazepine, or if still refractory, a barbiturate. Other complications such as bradycardia, hypotension and gastrointestinal upset should be treated along usual guidelines. Myoclonic jerking is a recognized re-emergence phenomenon and single episodes do not require treatment. A withdrawal syndrome is recognized after chronic abuse of this compound and may last 3 to 12 days. Benzodiazepines are usually effective to relieve symptoms. Weakness, headache, fatigue and nausea lasting 3 days after ingestion may occur. However, if significant CNS depressant effects persist beyond 8 hours, alternative causes should be investigated. |
The correct identification of the substance is important. If the symptoms are inconsistent with those described, or the history is considered unreliable, other substances may need to be considered. |
EMERGENCY STABILIZATION
Ensure Adequate Cardiopulmonary Function |
Ensure the airway is protected if compromised (intubation may be necessary). |
DECONTAMINATION
Decontamination Not Recommended |
Absorption is too rapid for decontamination to be effective.
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Supportive care is likely to be successful without decontamination.
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SIGNS AND SYMPTOMS
The correct identification of the substance is important. If the symptoms are inconsistent with those described, or the history is considered unreliable, other substances may need to be considered. |
Other drug/compounds are commonly co-ingested with this substance and may significantly influence the clinical picture. With mild toxicity, gastrointestinal upset may occur and CNS effects predominate including euphoria, CNS depression, headache, and occasionally miosis and nystagmus. Sudden drowsiness followed by profound coma is a characteristic presentation (a GCS of 3 is not uncommon). Recovery is sometimes accompanied by emergence phenomena including myoclonic jerking, transient confusion, and combativeness. With serious toxicity, sudden, profound coma, seizures, and respiratory arrest may occur. Deaths are reported.  Complications may include bradycardia, hypotension, and hypothermia. Persistent symptoms of weakness, headache, fatigue, and nausea lasting three days after ingestion has been noted, and a withdrawal syndrome is described. |
Onset/Duration of Symptoms |
Weakness, headache, fatigue, and nausea lasting three days after ingestion has been noted, and a withdrawal syndrome lasting 3 to 12 days is described. |
| Mild Gamma-Hydroxybutyrate Toxicity | Moderate Gamma-Hydroxybutyrate Toxicity | Severe Gamma-Hydroxybutyrate Toxicity | Euphoria Drowsiness Dizziness Headache Weakness | Bradycardia Hypotension Myoclonic jerking Hypothermia (mild) | Profound coma Seizure Respiratory arrest |
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Do Not Archive. This document is current on day of issue,
NZ: 18.May.2012 |
Disclaimer
All information contained on this database is as accurate and up-to-date as our resources allow. Since the University of Otago, the New Zealand National Poisons Centre and Intergen cannot anticipate or control the conditions under which this information may be used, each user should view the information in the specific context of the intended application.
The University of Otago, the New Zealand National Poisons Centre and Intergen will not be responsible for damages of any nature resulting from use or reliance upon this information.
© National Poisons Centre, New Zealand. Portions © Intergen.
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