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Gamma hydroxybutyrate (GHB) intoxication

Deborah L Zvosec, PhD
Stephen W Smith, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Gamma hydroxybutyrate (GHB) is a central nervous system (CNS) depressant first synthesized in France as an analog of gamma aminobutyric acid (GABA) and capable of crossing the blood brain barrier. Initially used as an anesthetic in Europe, GHB's inadequate analgesic effects and side effects, including myoclonus and emergence delirium, prevented approval in the United States (US) [1].

In the 1980s GHB was marketed as a bodybuilding and weight loss drug and sold in health food stores. Subsequently, use became more widespread as GHB was abused for euphoric, sexual, stimulant, and relaxant effects. Following reports of adverse effects and the enactment of government restrictions on GHB, the marketing of gamma butyrolactone (GBL) and 1,4 butanediol (BD), two common industrial solvents, as “dietary supplements” began. Both of these compounds are analogs or congeners of GHB, which when ingested are rapidly metabolized to GHB, with the same clinical effects. (See 'Pharmacology and cellular toxicology' below.)

GBL and BD have been sold spuriously as “non-toxic” and “organic” solvents, “cleaning products,” and “chemical samples” to avoid detection and prosecution [2]. Available formulations include industrial GBL and BD, street supplies, home-synthesized GHB (made from recipes available on the Internet), and pharmaceutical formulations. Internet websites, chat rooms, and forums have figured prominently in the dissemination of information and misinformation regarding GHB sources and supplies, use and effects, and legal status around the world [3-5]. (See 'Formulations and dosing' below.)

The toxicology and management of acute GHB intoxication are reviewed here. GHB withdrawal, the toxicology of other specific agents that may be coingested, and general management of the poisoned patient are discussed elsewhere. (See "Gamma hydroxybutyrate (GHB) dependence and withdrawal" and "MDMA (ecstasy) intoxication" and "Cocaine: Acute intoxication" and "General approach to drug poisoning in adults".)

Throughout this review we use the term "GHB" to refer to GHB and its analogs, unless specifically noted. The pharmacology of GHB and its analogs are discussed in the text. (See 'Pharmacology and cellular toxicology' below.)


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