Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity

Abstract

Background: γ-Hydroxybutyrate (GHB) is a drug of abuse with dose-dependent sedative effects. Systematic data on the acute toxicity of GHB from emergency department (ED) presentations over a long period of time are currently missing from the literature. The present study described the clinical features of GHB toxicity. Methods: Retrospective case series of GHB intoxications seen in an urban ED. Results: From January 2002 to September 2015, 78 GHB-related intoxication cases were recorded (71% male patients). The mean±SD age was 29±8years. The co-use of alcohol and/or other illicit drugs was reported in 65% of the cases. Neurological symptoms other than central nervous system depression included agitation (40%) and clonus (21%). The most frequent reasons for admission were coma (64%) and agitation (23%). The median time to regain consciousness was 90min (range, 3-400min). Sudden recovery was reported in 25 cases (32%). Coma was not significantly associated with polyintoxication. Coma occurred in 77 % of the alcohol co-users and in 62 % ofthe non-alcohol users (p=0.052). The mean recovery time in comatose patients was 142 min in patients with co-use of alcohol compared with 89 min in patients without alcohol co-use (p=0.07). Alcohol co-use was not significantly associated with nausea/vomiting (p=0.07). The co-use of stimulants was not significantly associated with non-responsive coma (Glasgow Coma Scale=3) or mean recovery time. Analytical confirmation of GHB was available in 37 cases (47%), with additional quantitative analysis in 20 cases. The median GHB concentration was 240mg/L (range, 8.3-373mg/L). Intoxication was severe in 72% of the cases. No fatalities occurred, and 72% of the patients were discharged directly home from the ED. Discussion: There were trend associations between alcohol co-use and frequency and length of coma and nausea/vomiting which did not reach the significance level (all p=0.05-0.07) but may nevertheless be clinically relevant. As the exact time of use is not always known, and co-use of other substances can affect the severity of poisoning, no definitive conclusions can be drawn regarding the association between GHB concentration and severity. Conclusion: Impaired consciousness and agitation were typical findings of GHB intoxication. The co-use of alcohol and/or other illicit substances is common but was not significantly associated with the severity of the intoxications in our study.