Presentation
We report two cases from Kansas City where the patients presented in, or developed profound coma. [ncbi.nlm.nih.gov]
Entire Body System
- Falling
CAUTION GHB's dose/response curve is similar to that of alcohol : At higher doses, users fall unconscious and are temporarily unable to be awakened (coma). It may also dangerously depress breathing. Avoid Mixing With Alcohol. [erowid.org]
Small doses produce relaxation, tranquility and drowsiness which make it extremely easy to fall asleep naturally. Higher doses increase the drowsiness effect and decrease the time it takes to fall asleep. [diagnose-me.com]
A number of these substances which fall outside of the current generic definition are offered for sale as new psychoactive substances. [gov.uk]
Gastrointestinal
- Vomiting
Common adverse effects include a rapid onset of drowsiness, nausea, vomiting, myoclonic seizures and coma of short duration. [ncbi.nlm.nih.gov]
GHB can also cause vomiting in combination with unconsciousness, which can be a fatal combination. It has also been known to cause breathing similar to Cheynes-Stokes Breathing. [erowid.org]
- Nausea
Other effects were headache, nausea, vomiting, myoclonic jerking, and short-term coma. There have been no reported deaths. If product use is discontinued, full recovery with no long-term side effects is universal. [ncbi.nlm.nih.gov]
Effects clumsiness, diarrhoea, dizziness, drowsiness, euphoria, headache, increased sex drive, lowered heart rate, lowered inhibitions, lowered temperature, memory lapses, nausea, urinary incontinence. [adf.org.au]
Neurologic
- Seizure
Coma and seizures have been reported following abuse of GHB, but dependence liability has received little attention. [ncbi.nlm.nih.gov]
Furthermore, these GHB-induced electroencephalogram-behavioral changes can be blocked by anticonvulsant drugs, which are specific in their action against petit-mal seizures. [jpet.aspetjournals.org]
- Insomnia
The most common patient symptoms were tremor (67%), hallucinations (63%), tachycardia (63%) and insomnia (58%). Seizures and rhabdomyolysis each occurred in 7% of cases, but only 1 death occurred. [ncbi.nlm.nih.gov]
The use of alcohol with Xyrem is a new contraindication (FDA warns against combined use) added to the Xyrem label, which already contraindicates its use with insomnia drugs. [web.archive.org]
BENEFITS # Treatment of Insomnia. GHB is a powerful sleep-inducing drug and has been used to treat insomnia by individuals since at least the 1980s. 2. Treatment of Sleep Disorders (narcolepsy). [erowid.org]
- Tremor
This manifested as delirium, tremor, and seizures despite only small decreases in GHB dose and treatment with benzodiazepines. [ncbi.nlm.nih.gov]
[…] used to taking it Whether other drugs are taken around the same time The following effects may begin within 15 to 20 minutes of taking GHB and may last for around 3 to 4 hours: Feelings of euphoria Increased sex drive Lowered inhibitions Drowsiness Tremors [adf.org.au]
- Amnesia
Among the possible described side-effects after the continued consumption of GHB are amnesia and deterioration of memory. Likewise, recent studies indicate the existence of neurotoxicity in certain brain regions after its prolonged treatment. [ncbi.nlm.nih.gov]
Amnesia is mainly present when GHB and benzodiazepines have been used; in particular, 1,4-benzodiazepines like flunitrazepam are more likely to cause amnesia than 1,5-benzodiazepines like clobazam ( 12 ). [doi.org]
Negative effects may include sweating, loss of consciousness, nausea, hallucinations, amnesia, and coma, among other side effects. [drugs.com]
- Confusion
The observed clinical symptoms ranged from confusion, disorientation, vomiting, and nystagmus to ataxia, sinus bradycardia, unconsciousness, and apnea. [ncbi.nlm.nih.gov]
Vomiting Irregular or shallow breathing Confusion, irritation and agitation Hallucinations Blackouts and memory loss Unconsciousness that can last for 3 to 4 hours Death 2 Long-term effects Little is known about the long-term effects of GHB use. [adf.org.au]
Features include auditory and visual hallucinations, tremors, tachycardia, hypertension, sweating, anxiety, agitation, paranoia, insomnia, disorientation, confusion, and aggression/combativeness. [doi.org]
Treatment
Benzodiazepine treatment of life-threatening gamma-hydroxybutyrate (GHB) withdrawal is frequently unsatisfactory. Animal studies suggest strongly that treatment with GABA(B) agonists, such as baclofen, will be a more effective strategy. [ncbi.nlm.nih.gov]
Prognosis
Prognosis With isolated use of GHB, prognosis is normally good. Spontaneous recovery of consciousness is usual, within 2-6 hours. [ 23 ] With repeated use, evidence exists for the development of tolerance and physical dependence. [patient.info]
Prognosis The prognosis varies. Although most patients live until adulthood, neuropsychiatric symptoms can be disabling, decreasing quality of life. Early mortality, including sudden unexpected death in epilepsy patients (SUDEP), has been reported. [orpha.net]
They concluded that “the prognosis for people who experience GHB poisoning is quite good.” The degree to which the pleasant state of GHB euphoria may be psychologically addicting may not be fully appreciated. [ceri.com]
Long-term prognosis in different types”, Forensic Science International, 36: 121-138. Lesch O.M., Walter H., Bonte W., Gruenberger M., Musalek M., Sprung R. (1991), “Chronic alcoholism: subtypes useful for therapy and research”, in Palmer T.N. [journals.francoangeli.it]
Etiology
[…] metabolized to CO 2 ). 2 Gas chromatography mass spectrometry will detect GHB up to 6-8 hours post administration, however, this form of advanced analysis is rarely available onsite. 2 Patients with > 6 hours of CNS depression => evaluate for alternative etiologies [emdocs.net]
Etiology SSADH deficiency is due to mutations in the ALDH5A1 gene (6p22), encoding mitochondrial succinate-semialdehyde dehydrogenase, a protein involved in amino-acid degradation. [orpha.net]
Epidemiology
Epidemiology. There is limited information regarding statistical trends on world-wide use of GHB and its analogs. [doi.org]
Department of Health and Human Services: National Institute on Drug Abuse Epidemiologic Trends in Drug Abuse, Volume I: Highlights and Executive Summary, June 2001, Community Epidemiology Work Group. www.drugabuse.gov/PDF/CEWG/EXSUMJune01.pdf Epidemiologic [web.archive.org]
Pathophysiology
Our understanding of the pathophysiological mechanisms of ASs has been greatly advanced by the availability of genetic and pharmacological models, in particular the γ-hydroxybutyrate (GHB) model which, in recent years, has been extensively used in studies [ncbi.nlm.nih.gov]
Some considerations on the pathophysiology of generalized bilaterally synchronous spike and wave discharge. Epilepsia 9, 249-263 (1968). 32. [books.google.com]
Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. Available online at http://www.ncbi.nlm.nih.gov/pubmed/10634967. Accessed June 2016. [labtestsonline.it]
Prevention
While the drug treatment literature has a wealth of information to draw upon, GHB-specific information may greatly assist relapse prevention. . American Academy of Addiction Psychiatry. [ncbi.nlm.nih.gov]
Objectives: To evaluate the efficacy and safety of GHB for the treatment of AWS and the prevention of relapse. [cochrane.org]