What is Gamma-Hydroxybutyrate Toxicity?
Gamma hydroxybutyrate (GHB) was first created in 1960 and was originally used as a type of anesthetic, a drug used to reduce or prevent feeling, especially during surgery. However, it wasn’t widely adopted in medical care because it didn’t provide great pain relief and it had negative side effects, like causing seizure-like activities. Despite these shortcomings, GHB became popular as a supplement for better sleep, bodybuilding, and weight loss.
In 1990, the United States Food and Drug Administration, which ensures the safety and effectiveness of drugs, banned GHB. Right now, it’s classified as a Schedule I drug in the United States. This means it’s a substance that has a high potential for abuse and no accepted use in medical treatment. GHB has earned a bad reputation as a “date rape drug” due to its illegal use in situations of sexual assault. It’s also used illegally for recreation, commonly at dance clubs and parties. People may refer to this drug on the street as G, Gamma OH, Georgia Home Boy, Liquid Ecstasy, and Liquid X.
What Causes Gamma-Hydroxybutyrate Toxicity?
GHB, a substance often used for its mind-altering effects, can be easily made and is typically found on the street as a clear, odorless liquid or powder. It’s often sold in small shampoo-sized bottles. Only a little bit of this substance, which has a salty or soapy taste, is needed to give users a quick, intense feeling of happiness. However, if used with alcohol or other substances, the taste might be hidden. The intensity and purity of GHB can vary greatly, which makes it hard for users to accurately know how much is too much and could potentially harm them. Misleading information online often downplays the dangerous lethal effects of GHB, and promotes its use as a drug for gaining muscle or for use in clubs.
Risk Factors and Frequency for Gamma-Hydroxybutyrate Toxicity
It’s challenging to understand how many people in the United States use GHB, a type of drug, due to limited data. There’s also not enough information on how often it leads to death or illness. One of the reasons for this lack of information is that GHB is often mistaken for other drugs and is not usually tested for in regular drug tests. However, the information that is available tells us that the majority of GHB users are young, white, middle-class men. This includes groups of people who use drugs at parties and among gay men. It’s also been reported that many people who come to the emergency department due to GHB also use other drugs like alcohol, cocaine, marijuana, ketamine, ecstasy (MDMA), and methamphetamines.
- Info on GHB use in the U.S is limited.
- It’s often hard to track GHB because it’s mistaken for other drugs.
- Most GHB users are young, white, middle-class men.
- GHB use is common among party drug users and gay men.
- Many GHB users also use alcohol, cocaine, marijuana, ketamine, ecstasy, and methamphetamines.
Signs and Symptoms of Gamma-Hydroxybutyrate Toxicity
GHB, a drug, can cause different reactions in users which may start as soon as 15 minutes after use. Common experience includes initial loss of restraint and a state of intense happiness. The most common effect of harmful GHB use is suddenly passing out, only to awaken just as suddenly a few hours later. The severity of these symptoms is related to the dosage taken – higher doses result in more severe impacts on breathing and the central nervous system (CNS). It’s not uncommon for users to become restless or confrontational before, during, or after a long sleep or unconscious state. Additional effects on the CNS can include memory loss, muscle spasms and seizure-like conditions. Other effects may also include slower heart rate, low blood pressure, apnea, vomiting, and lowered body temperature.
Getting a reliable account of events from patients may be challenging due to their altered mental states. However, there can be signs pointing to GHB use, such as the presence of empty mini shampoo bottles (as GHB is often stored in them), evidence of attendance at a party or nightclub, or potential instances of sexual abuse.
Testing for Gamma-Hydroxybutyrate Toxicity
If your doctor suspects that you may be suffering from GHB toxicity, they will diagnose it based on your symptoms and clinical signs. This is because in most hospitals, there are no routine tests available to detect GHB in your blood or urine. There is a specific test that uses gas chromatography and mass spectrometry, which are sophisticated lab techniques, but it can take up to one to two weeks to get the results.
However, a urine drug test may be used to help determine if you may have taken other substances alongside GHB. As part of the standard assessment for anyone who may have taken a toxic substance, your doctor will also check your blood sugar level, blood alcohol level, and the levels of common over-the-counter drugs like acetaminophen and salicylates (a type of painkiller).
In addition, you may have a CT scan of your head or other types of imaging tests if your doctor thinks you might have suffered an injury or trauma. This precaution is taken to make sure any such injuries are detected and treated properly.
Treatment Options for Gamma-Hydroxybutyrate Toxicity
There isn’t a specific cure for GHB toxicity, a condition caused by the drug overdose. The primary treatment involves ensuring the patient’s ability to breathe and close monitoring. Doctors or medical staff will usually monitor the patient’s heart and breathing rates, and use gadgets such as finger pulse monitors (pulse oximetry) and capnography (to measure carbon dioxide in the patient’s breath) whenever possible.
Patients suffering from a GHB overdose can experience severe difficulties in breathing or even stop breathing altogether. It’s crucial to check and maintain the patient’s airway in such cases. In less serious cases, supplying additional oxygen via a nose tube or mask may be enough to support the patient until they fully regain consciousness. However, in more severe cases, a tube may be inserted into the patient’s windpipe (a procedure known as endotracheal intubation) to assist their breathing.
Patients affected by GHB are normally awake and conscious during mechanical ventilation, often suddenly waking up and needing urgent removal of the breathing tube. Additionally, conditions like severe slowing of the heart can be managed with the use of a medicine called atropine, and a condition called hypotension, better known as low blood pressure, is often aided with the use of intravenous (IV) fluids.
If there’s a suspicion that the patient might have also taken opioids, another class of strong painkillers which can cause toxicity, doctors might consider using a medicine called naloxone, given as an IV injection. Once the patient is awake, free from symptoms and it is confirmed that there are no other drugs overdoses or injuries, they can typically return home safely.
What else can Gamma-Hydroxybutyrate Toxicity be?
The following conditions could require urgent medical attention:
- Acute hypoglycemia (sudden low blood sugar)
- Acute subdural hematoma in the emergency department (bleeding on the brain)
- Alcohol toxicity (alcohol poisoning)
- Antidepressant toxicity (poisoning from antidepressant overdose)
- Barbiturate toxicity (poisoning from barbiturate overdose)
- Benzodiazepine toxicity (poisoning from benzodiazepines overdose)
- Carbon monoxide toxicity (carbon monoxide poisoning)
- Cocaine toxicity (cocaine poisoning)
- Delirium tremens (alcohol withdrawal)
- Emergent management of subarachnoid hemorrhage (urgent care for bleeding into the space surrounding the brain)
- Encephalitis (brain inflammation)
- Epidural hematoma in emergency medicine (bleeding between the skull and outer layer of the brain)
- Ethylene glycol toxicity (poisoning from ethylene glycol, often found in substances like antifreeze)
