DESCRIPTION
USES
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) |
INTERVENTION CRITERIA
The correct identification of the substance is important. If the symptoms are inconsistent with those described in the literature, or the history is considered unreliable, other substances may need to be considered. |
Medical assessment and observation is recommended for: - Any suspected ingestion in children The risks of decontamination outweigh any benefits, and should not be attempted. |
Medical assessment and observation is recommended for: - Any suspected ingestion - Exposures with intent to self-harm 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 4 hours following exposure for onset or worsening of symptoms. |
If the patient is asymptomatic at the end of the observation period, and provided that appropriate assessment and investigations have been completed, they may be: Discharged into the care of a reliable observer, or Referred for psychological assessment if the overdose or exposure was with intent to self-harm |
Serum concentrations do not aid management. |
Monitor: Level of consciousness Heart rate Blood pressure Respirations Seizure activity |
Admission to an intensive care environment is recommended for patients who develop significant signs of toxicity including: CNS depression requiring intubation Respiratory depression Aspiration pneumonitis Hemodynamic instability |
TREATMENT
TREATMENT SUMMARY
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
Ensure Adequate Cardiopulmonary Function |
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 |
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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ANTIDOTE(S)
There Are No Antidotes For This Substance |
There are no specific antidotes for this overdose.  Agents including naloxone, flumazenil, and physostigmine have been investigated as potential antidotes. None have shown consistent results in reversing intoxication. |
SIGNS AND SYMPTOMS
The correct identification of the substance is important. If the symptoms are inconsistent with those described in the literature, 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 CNS depression, euphoria, ataxia, disorientation, dizziness, 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 agitation and combativeness.  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 |
Mild Gamma-Hydroxybutyrate Toxicity | Moderate Gamma-Hydroxybutyrate Toxicity | Severe Gamma-Hydroxybutyrate Toxicity | Euphoria Drowsiness Dizziness Confusion Disorientation Vomiting | Bradycardia Hypotension Myoclonic jerking Hypothermia (mild) Agitation Ataxia Miosis | Respiratory depression Profound coma Rhabdomyolysis Seizure Respiratory arrest |
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Do Not Archive. This document is current on day of issue,
NZ: 21.Jan.2021 |
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