This substance may be used therapeutically but can also be subject to abuse.

 

Treatment for narcolepsy

Treatment for alcoholism

Anesthetic agent

Euphoric

“Date rape” agent

“Growth Hormone booster”

“Aphrodisiac”

“Muscle builder” (although effectiveness has never been proven)

 

Emergency stabilization may be required for respiratory depression and/or pulmonary aspiration, immediate assessment and management of respiratory compromise is a priority. Due to fast onset of action, gastrointestinal decontamination is not recommended.

 

There is no proven antidote for poisoning. Extracorporeal elimination techniques would not be anticipated to be of clinical benefit in the majority of patients as most will satisfactorily recover with adequate airways management alone.

 

Supportive care is the mainstay of management, with primary emphasis on airway management and cardiovascular support. Airway protection including endotracheal intubation and/or assisted ventilation may be necessary due to respiratory depression and aspiration risk. 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. Myoclonic jerking is a recognized re-emergence phenomenon and single episodes do not require treatment. Other complications such as bradycardia, hypotension, hypothermia, and gastrointestinal upset should be treated along usual guidelines.

 

A sedative-hypnotic withdrawal syndrome is recognized after chronic abuse of this compound and may last 3 to 21 days. Benzodiazepines are usually effective to relieve symptoms, but high doses may be required. Severe cases of GHB withdrawal may be refractory to benzodiazepines and benefit from treatment with baclofen or barbiturates. Consultation with a medical toxicologist or poison center is recommended for cases of refractory GHB withdrawal.

 

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.

 

Emergency Stabilization

Decontamination

Antidote(s)

Enhanced Elimination

Supportive Care

Ensure the airway is protected if compromised (intubation may be necessary).

 

Establish secure intravenous access if hypotensive.

 

Airway

Breathing

Blood pressure

Heart rate/rhythm

Core body temperature

Blood oximetry

 

Absorption is too rapid for decontamination to be effective.

Supportive care is likely to be successful without decontamination.

There are no specific antidotes for this overdose.[1]

 

Agents including naloxone, flumazenil, and physostigmine have been investigated as potential antidotes. None have shown consistent results in reversing intoxication.

 

Physostigmine is viewed as an unproven experimental antidote for this intoxication. It was initially investigated as a reversal agent in patients under GHB-induced anesthesia.[2][3] However, use following poisoning has produced differing results, with the majority of patients not showing response.[4][5][6] Reviews of the literature have shown there is not sufficient evidence to support the use of physostigmine in acute GHB overdose.[6][7] At this stage physostigmine is not recommended.[1]

 

Additionally, naloxone and flumazenil have been used following human poisoning, both have had limited effect on reversing toxicity.[8][9][10][11][12] Neither of these compounds can be recommended.[1]