A Tale of Novel Intoxication: Seven Cases of gamma-Hydroxybutyric Acid Overdose
James Li MD*
Sharon Arnaud Stokes MD
Anna Woeckener MD*
--------------------------------------------------------------------------------
From the Departments of Emergency Medicine* and Medicine, Charity Hospital, New Orleans, LA.
Received for publication February 17, 1997.
Revisions received May 16 and July 11, 1997, and February 18, 1998.
Accepted for publication March 5, 1998.
--------------------------------------------------------------------------------
Address for reprints: James Li, MD, Mount Auburn Hospital, Department of Emergency Medicine, 330 Mount Auburn Street, Cambridge, MA 02238, E-mail
[email protected]
Copyright ? 1998 by the American College of Emergency Physicians.
47/1/90301
Study Objective: We describe seven patients presenting with combination substance abuse involving gamma-Hydroxybutyric acid (GHB).
Methods: During a 3-month period, we identified consecutive patients with GHB ingestion confirmed by urine mass spectrometry presenting to a high-volume urban emergency department.
Results: All patients presented with acute delirium and transient but severe respiratory depression. With supportive care, including intubation and mechanical ventilation in four cases, normal mentation and respiratory function returned within 2 to 6 hours. None of these patients had documented seizures, and none of the four patients who received naloxone had a reversal response. This clinical observation supports previous experimental work in GHB-intoxicated human subjects demonstrating neither epileptiform changes on electroencephalography nor reversal with naloxone. Two findings are remarkable in this series. The first is the observation of a peculiar state of violent aggression present on stimulation of the GHB-intoxicated patient despite near or total apnea. The fact that patients fully recovered from this state may be the result of a previously demonstrated GHB hypoxia-sparing effect. The second is the observation of ECG abnormalities in several cases, including U waves in five patients.
Conclusion: Emergency physicians should be alerted to this agent, its characteristic effects, and its potential for serious sequelae including respiratory arrest and death.
[Li J, Stokes SA, Woeckener A: A tale of novel intoxication: Seven cases of gamma-Hydroxybutyric acid overdose. Ann Emerg Med June 1998;31:723-728.]
