Gamma Hydroxybutyrate Toxicity - Symptoms, Side Effects, Diagnosis, and Treatment

Introduction:

Gamma hydroxybutyrate is an endogenous brain chemical synthesized in the labs as a synthetic chemical. GHB is typically a party drug used for recreational purposes by drug abusers. This drug is also labeled as a “date rape drug” used to facilitate sexual assault by people and is thus considered illegal.

Gamma hydroxybutyrate is an active ingredient in sodium oxybate, a prescription medication for narcolepsy or excessive daytime sleeping. It is approved by the U.S. Food and Drugs Administration (FDA). It is also possibly effective as general anesthesia and for managing alcoholism and cataplexy conditions. GHB is also in small quantities in wines, beers, citrus fruits, and beef. The street drug is also commonly named “Liquid ecstasy,” “Liquid X,” “Georgia Home Boy,” and “Easy Lay.” GHB is unsafe and is not legal to use as a dietary supplement.

What Are the Side Effects Produced by Gamma Hydroxybutyrate Toxicity?

The side effects produced by gamma-hydroxybutyrate toxicity are as follows:

Moderate Dose Side Effects:

• Euphoria.

• Relaxation.

• Sociability.

• Drowsiness.

• Touch sensitivity.

• Increased sexual drive.

• Extreme lack of inhibition (mental, behavioral, personality disorders).

High Dose Side Effects:

• Vomiting.

• Nausea.

• Dizziness.

• Tremors.

• Hallucinations.

• Seizures.

• Lack of coordination.

• Agitation, confusion, irritation.

• Memory loss and blackouts.

• Coma.

• Respiratory arrest.

• Death.

The adverse effects caused by gamma-hydroxybutyrate include:

• GBH or gamma- hydroxybutyrate interaction with alcohol and other drugs has caused severe respiratory depression and deaths in many reported cases. In addition, GBH prevents the elimination rate of alcohol from the body, and ingesting both can cause fatal consequences.

• Many studies have reported the neurotoxicity caused by GBH by inducing oxidative stress and affecting the cerebral cortex.

• Studies have also shown that prescription sodium oxybate drugs have caused toxicity and death among people. Some were due to intentional drug overdose, while others were caused due to criminal activity by giving GBH as poison.

• GBH impairs memory with chronic intoxication and concentration levels.

• Repeated drug consumption causes an imbalance in the brain circuits leading to an irresistible urge to take drugs and causing drug addiction.

• Withdrawal syndrome is also associated with gamma hydroxybutyrate, which can be severe and may need hospitalization to manage symptoms like acute delirium.

What Are the Gamma Hydroxybutyrate Overdose Symptoms?

The metabolism of GHB in the body starts within 15 minutes after ingestion, and the stage is called euphoria by the drug abusers. The clinical effects and peak plasma concentration are approximately 30 to 60 minutes.

The toxicity symptoms and impact duration produced mainly depend on the dose of the drug ingested. GHB is a lipid-soluble drug and can easily cross the blood-brain barrier of the body cells and tissues. The drug's half-life is usually 20 to 50 minutes and is eliminated depending upon the dose of the medicine. Lowe doses (10 to 30 mg/kg) of GHB have sedative effects and cause sleep, whereas the higher doses (50mg/kg) cause respiratory depression, coma, and bradycardia.

The GBH overdose symptoms include:

• A person appears sleepy, unconscious, and cannot be awakened.

• A person is confused, incoherent, vomiting, sweating, and has shallow or slow breathing.

• In addition, a person has involuntary muscle contractions, difficulty standing, and a lack of coordination.

Why Is Gamma Hydroxybutyrate Abused as a Drug?

GHB is abused for the following reasons:

• Sleep enhancement and bodybuilding.

• Relaxant and stimulant effects.

• Sexual drive and euphoric effects.

• Drugging for sexual assault purposes.

How Is Gamma Hydroxybutyrate Toxicity Diagnosed?

• Gamma hydroxybutyrate is not instantly detectable in urine screening but can be used to identify other co-ingestants that can be excluded from the GHD diagnosis.

• The doctor can clinically diagnose the toxicity caused by GHB through gas chromatography and mass spectrometry. These diagnostic processes usually take 7 to 14 days for test results.

• Other tests include acetaminophen levels, fingerstick glucose, salicylate level, and blood alcohol level.

• The doctor also uses radiological tests to check for suspected trauma or injury.

How Is Gamma Hydroxybutyrate Toxicity Treated?

• There is no specific antidote available for GHB toxicity.

• Supportive treatment is given to a patient, and vital signs are continuously monitored.

• Airway obstruction or respiratory depression is managed by oxygen therapy in milder cases.

• In severe cases of respiratory depression, the airway is maintained by endotracheal intubation or mechanical ventilation. The respiratory support is removed when the patient awakens.

• Severe hypotension is managed with intravenous fluids, and atropine is given in severe bradycardia(slow heart rate) conditions.

• If a person has also ingested opioids along with GHB, naloxone should be considered for treating opioid toxicity cases.

What Are the Precautions or Warnings for Gamma Hydroxybutyrate?

• GBH prescription drug (sodium oxybate) is safe to ingest through the mouth under the doctor's supervision for narcolepsy. But GBH is unsafe to be used as a dietary supplement as it causes side effects such as memory loss, confusion, hallucinations, coma, and death. The side effects caused can be managed by the healthcare provider.

• Gamma hydroxybutyrate can slow down the heart rate (bradycardia). Therefore, GBH should not be consumed without medical advice.

• GBH should not be used during pregnancy and breastfeeding as it can cause life-threatening side effects, making it unsafe for pregnant women and newborns.

• Epileptic people should not use this drug as it can cause seizures.

• GHB is a central nervous system depressant and can induce sleep if given along with anesthesia during surgeries. Therefore, a person using this drug should stop consuming it for at least two weeks before and after the surgery.

What Is the Differential Diagnosis for Gamma Hydroxybutyrate Toxicity?

The differential diagnosis for GBH are as follows:

• Barbiturate toxicity.

• Benzodiazepine toxicity.

• Encephalitis.

• Carbon monoxide toxicity.

• Alcohol toxicity.

• Acute hypoglycemia.

• Antidepressant toxicity.

• Delirium tremens.Epidural hematoma.

Conclusion:

Gamma hydroxybutyrate is a widely used drug that can produce relaxation and euphoric effects. It is a potent depressant and sedative for various criminal and foul play scenarios. Toxicity caused by the overdose or misuse of gamma hydroxybutyrate can cause severe respiratory depression and other fatal consequences such as coma or death.

The drug is known to cause addiction and dependency, but its long-term effects are still not known. GBH intoxication can produce severe adverse effects that are nonspecific to drug toxicity and can be confused with other depressants. Therefore, a person consuming these drugs should be careful with the prescription drug dosage and recreational use. An abused or overdosed person must not be delayed getting medical help.