Skip to main content

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
Cancel
×
×
Home
  • Home
Article
  • Cited by 38
  • Cited by
    Crossref Citations
    Crossref logo
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.
    Hu, Sally Singh, Mandeep Wong, Jean Auckley, Dennis Hershner, Shelley Kakkar, Rahul Thorpy, Michael J. and Chung, Frances 2018. Anesthetic Management of Narcolepsy Patients During Surgery. Anesthesia & Analgesia, Vol. 126, Issue. 1, p. 233.
    Wood, David M. 2017. Critical Care Toxicology. p. 1555.
    Kamal, Rama M. van Noorden, Martijn S. Wannet, Wim Beurmanjer, Harmen Dijkstra, Boukje A. G. and Schellekens, Arnt 2017. Pharmacological Treatment in γ-Hydroxybutyrate (GHB) and γ-Butyrolactone (GBL) Dependence: Detoxification and Relapse Prevention. CNS Drugs, Vol. 31, Issue. 1, p. 51.
    Dignam, G and Bigham, C 2017. Novel psychoactive substances: a practical approach to dealing with toxicity from legal highs. BJA Education, Vol. 17, Issue. 5, p. 172.
    McNulty, Maggie L. Luft, Andreas and Bleck, Thomas P. 2017. Seizures in Critical Care. p. 343.
    von Theobald, Louis Rousselet, Morgane Cholet, Jennyfer Debar, Hélène Boels, David Victorri-Vigneau, Caroline and Grall-Bronnec, Marie 2017. Inpatient Gamma-Hydroxybutyrate Detoxification. Journal of Addiction Medicine, Vol. 11, Issue. 3, p. 231.
    van Noorden, Martijn S. Mol, Ton Wisselink, Jeroen Kuijpers, Wil and Dijkstra, Boukje A.G. 2017. Treatment consumption and treatment re-enrollment in GHB-dependent patients in The Netherlands. Drug and Alcohol Dependence, Vol. 176, Issue. , p. 96.
    van Noorden, Martijn Kamal, Rama Dijkstra, Boukje Brunt, T.M. and de Jong, Cor 2016. Neuropathology of Drug Addictions and Substance Misuse. p. 379.
    Weibell, Melissa A. ten Velden Hegelstad, Wenche and Johannessen, Jan Olav 2016. Neuropathology of Drug Addictions and Substance Misuse. p. 50.
    Wood, David M. 2016. Critical Care Toxicology. p. 1.
    Kamal, Rama M. Dijkstra, Boukje A.G. Loonen, Anton J. and De Jong, Cornelis A.J. 2016. The Effect of Co-occurring Substance Use on Gamma-hydroxybutyric Acid Withdrawal Syndrome. Journal of Addiction Medicine, Vol. 10, Issue. 4, p. 229.
    Kamal, Rama M. Loonen, Anton J. M. Dijkstra, Boukje A. G. and De Jong, Cornelis A. J. 2015. Baclofen as Relapse Prevention in the Treatment of Gamma-Hydroxybutyrate Dependence. Journal of Clinical Psychopharmacology, Vol. 35, Issue. 3, p. 313.
    Domínguez, Iria Bruguera, Pol Balcells-Oliveró, Mercè and Batalla, Albert 2015. Depression Following γ-Hydroxybutyrate Withdrawal. Journal of Clinical Psychopharmacology, Vol. 35, Issue. 5, p. 618.
    Corkery, John M. Loi, Barbara Claridge, Hugh Goodair, Christine Corazza, Ornella Elliott, Simon and Schifano, Fabrizio 2015. Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use. Neuroscience & Biobehavioral Reviews, Vol. 53, Issue. , p. 52.
    Ingels, Ann-Sofie M. E. Wille, Sarah M. R. Samyn, Nele Lambert, Willy E. and Stove, Christophe P. 2014. Screening and confirmation methods for GHB determination in biological fluids. Analytical and Bioanalytical Chemistry, Vol. 406, Issue. 15, p. 3553.
    Brust, John C. M. 2014. Neurologic Complications of Illicit Drug Abuse. CONTINUUM: Lifelong Learning in Neurology, Vol. 20, Issue. , p. 642.
    GHIO, LUCIO CERVETTI, ALICE RESPINO, MATTEO MURRI, MARTINO BELVEDERI and AMORE, MARIO 2014. Management and Treatment of Gamma Butyrolactone Withdrawal Syndrome. Journal of Psychiatric Practice, Vol. 20, Issue. 4, p. 294.
    Seiffert, Ernst Mothersill, Ian Krämer, Günter and Dorn, Thomas 2013. γ-Hydroxybutyrate–Associated Encephalopathy and Excitation Documented With Electroencephalogram and Video. Journal of Clinical Psychopharmacology, Vol. 33, Issue. 3, p. 442.
    Choudhuri, Debajeet Cross, Sean Dargan, Paul I. Wood, David M. and Ranjith, Gopinath 2013. Psychiatric aspects of acute withdrawal from gamma-hydroxybutyrate (GHB) and its analogue gamma-butyrolactone (GBL): implications for psychiatry services in the general hospital. International Journal of Psychiatry in Clinical Practice, Vol. 17, Issue. 2, p. 154.
    Batalla, Albert Ilzarbe, Daniel González, Jaime and Soler, Victoria 2012. Síndrome de abstinencia por consumo abusivo de precursores de éxtasis líquido. Medicina Clínica, Vol. 139, Issue. 4, p. 181.
    Download full list
    ×
  • Access

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

  • Jeremy M. Wojtowicz (a1) (a2), Mark C. Yarema (a1) (a3) and Paul M. Wax (a4)
Abstract

1,4-Butanediol (1,4-BD) is an industrial solvent that is metabolized to gamma-hydroxybutyrate (GHB), a gamma-aminobutyric acid agonist and central nervous system depressant. GHB and its analogues are popular drugs of abuse. Withdrawal from these agents is characterized by autonomic instability and altered mental status. We report a case of withdrawal from 1,4-BD lasting 6 days and complicated by new onset of seizures and rhabdomyolysis. In addition, we conducted a systematic review of the English literature pertaining to withdrawal from GHB, 1,4-BD and gamma-butyrolactone (GBL). Data collected from source articles included last use prior to symptom onset, clinical features on presentation, duration of symptoms and outcome. Twenty-seven studies with 57 episodes of withdrawal were included. Thirty-six cases (63%) involved GHB, 3 cases (5%) involved 1,4-BD and 18 (32%) involved GBL. 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. Emergency physicians must consider withdrawal from these agents when patients present with clinical features suggestive of a sedative-hypnotic withdrawal syndrome.

    •
      • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review
      Available formats
      ×
Copyright
COPYRIGHT: © Canadian Association of Emergency Physicians 2008
Corresponding author
Department of Emergency Medicine, Room C231 Foothills Medical Centre, 1403-29 St. NW, Calgary AB T2N 2T9; jmwojtow@ucalgary.ca
References
Hide All
1.Dyer, J. Gamma-hydroxybutyrate: a health food product producing coma and seizure like activity. Am J Emerg Med 1991;9: 321–4.
2.Zvosec, DL, Smith, SW, McCutcheon, JD, et al. Adverse events, including death, associated with the use of 1,4-Butanediol. N Engl J Med 2001;344:87–94.
3.Takahara, J, Yunoki, S, Yakushiji, W, et al. Stimulatory effects of gamma-hydroxybutyric acid on growth hormone and prolactin release in humans. J Clin Endocrinol Metab 1977;44:1014–7.
4.Controlled Drugs and Substances Act. 1996, c. 19 Available: http://laws.justice.gc.ca/en/ShowFullDoc/cs/C-38.8///en (accessed 2007 Nov 21).
5.Dyer, JE, Roth, B, Hyma, BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37:147–53.
6.Craig, K, Gomez, HF, McManus, JL, et al. Severe gamma-hydroxybutyrate withdrawal: a case report and literature review. J Emerg Med 2000;18:65–70.
7.Catalano, MC, Glass, JM, Catalano, G, et al. Gamma butyrolactone (GBL) withdrawal syndromes. Psychosomatics 2001;42:83–8.
8.Greene, T, Dougherty, T, Rodi, A. Gamma-butyrolactone (GBL) withdrawal presenting as acute psychosis. J Toxicol Clin Toxicol 1999;37:651.
9.Herold, AH, Sneed, KB. Treatment of a young adult taking gamma-butyrolactone (GBL) in a primary care clinic. J Am Board Fam Pract 2002;15:161–3.
10.McDaniel, CH, Miotto, KA. Gamma hydroxybutyrate (GHB) and gamma butyrolactone (GBL) withdrawal: five case studies. J Psychoactive Drugs 2001;33:143–9.
11.Mycyk, MB, Wilemon, C, Aks, SE. Two cases of withdrawal from1,4-butanediol use. Ann Emerg Med 2001;38:345–6.
12.Reeves, J, Duda, R. GHB/GBL intoxication and withdrawal: a review and case presentation. Addictive Disorders & Their Treatment 2003;2:25–8.
13.Schneir, AB, Ly, BT, Clark, RF. A case of withdrawal from the GHB precursors gamma-butyrolactone and 1,4-Butanediol. J Emerg Med 2001;21:31–3.
14.Sharma, AN, Nelson, L, Hoffman, RS. Severe gamma butyrolac-tone withdrawal. J Toxicol Clin Toxicol 2000;38:535.
15.Sivilotti, MLA, Burns, MJ, Aaron, CK, et al. Pentobarbital for severe gamma-butyrolactone withdrawal. Ann Emerg Med 2001;38:660–5.
16.Wojtowicz, JM, Yarema, MC, Wax, PM. A case of prolonged withdrawal from use of 1,4-butanediol complicated by seizure and rhabdomyolysis [abstract]. CJEM 2006;8:195.
17.Tarabar, AF, Nelson, LS. The gamma-hydroxybutyrate withdrawal syndrome. Toxicol Rev 2004;23:45–9.
18.Goldfrank, LR, Flomenbaum, NE, Lewin, NA, et al. Goldfrank’s toxicologic emergencies. 7th ed. New York (NY): McGraw-Hill; 2002.
19.Ford, MD, Ling, LJ, Delaney, KA, et al. Clinical toxicology. 1st ed. Philadelphia (PA): W.B. Saunders; 2001.
20.Haddad, LM, Shannon, MW, Winchester, JF. Clinical management of poisoning and drug overdose. 3rd edition. Philadelphia (PA): W.B. Saunders; 1997.
21.Gonzalez, A, Nutt, DJ. Gamma hydroxyl butyrate abuse and dependency. J Psychopharmacol 2005;19:195–204.
22.Miotto, K, Darakjian, J, Basch, J, et al. Gamma-hydroxybutyric acid: patterns of use, effects and withdrawal. Am J Addict 2001;10:232–41.
23.Mullins, ME, Fitzmaurice, SC. Lack of efficacy of benzodiazepines in treating gamma-hydroxybutyrate withdrawal. J Emerg Med 2001;20:418–9.
24.Garvey, R, Fitzmaurice, B. Withdrawal delirium with dance drug ‘liquid ecstasy’ (GHB). Ir J Psych Med 2004;21:73–5.
25.Dyer, JE, Andrews, KM. Gamma hydroxybutyrate withdrawal. J Toxicol Clin Toxicol 1997;35:553–4.
26.Dyer, JE, Roth, B, Hyma, BA. GHB withdrawal syndrome: 8 cases. J Toxicol Clin Toxicol 1999;37:650.
27.Galloway, GP, Frederick, SL, Staggers, F Jr. Physical dependence on sodium oxybate. Lancet 1994;343:57.
28.Chew, G, Fernando, A. III. Epileptic seizure in GHB withdrawal. Australas Psychiatry 2004;12:410–1.
29.Chin, RL. A case of severe withdrawal from gamma-hydroxybutyrate. Ann Emerg Med 2001;37:551–2.
30.Addolorato, G, Caputo, F, Capristo, E, et al. A case of gamma-hydroxybutyric acid withdrawal syndrome during alcohol addiction treatment: utility of diazepam administration. Clin Neuropharmacol 1999;22:60–2.
31.Bowles, TM, Sommi, RW, Amiri, M. Successful management of prolonged gamma-hydroxybutyrate and alcohol withdrawal. Pharmacotherapy 2001;21:254–7.
32.Friedman, J, Westlake, R, Furman, M. ‘Grievous bodily harm:’ gamma hydroxybutyrate abuse leading to a Wernicke-Korsakoff syndrome. Neurology 1996;46:469–71.
33.Galloway, GP, Frederick, SL, Staggers, FE Jr, et al. Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence. Addiction 1997;92:89–96.
34.Glasper, A, McDonough, M, Bearn, J. Within-patient variability in clinical presentation of gamma-hydroxybutyrate withdrawal a case report. Eur Addict Res 2005;11:152–4.
35.Hernandez, M, McDaniel, CH, Costanza, CD, et al. GHB-induced delirium: a case report and review of the literature on gamma hydroxybutyric acid. Am J Drug Alcohol Abuse 1998;24:179–83.
36.Hutto, B, Fairchild, A, Bright, R. gamma-Hydroxybutyrate withdrawal and chloral hydrate. Am J Psychiatry 2000;157:1706.
37.Mahr, G, Bishop, CL, Orringer, DJ. Prolonged withdrawal from extreme gamma-hydroxybutyrate (GHB) abuse. Psychosomatics 2001;42:439–40.
38.Miglani, JS, Kim, KY, Chahil, R. Gamma-hydroxybutyrate withdrawal delirium: a case report. Gen Hosp Psychiatry 2000;22:213–6.
39.Price, G. In-patient detoxification after GHB dependence. Br J Psychiatry 2000;177:181.
40.Rosenberg, MH, Deerfield, LJ, Baruch, EM. Two cases of severe gamma-hydroxybutyrate withdrawal delirium on a psychiatric unit: recommendations for management. Am J Drug Alcohol Abuse 2003;29:487–96.
41.Slagel, B, Kingstone, E, Bhalerao, S. Gamma hydroxybutyrate withdrawal in an orthopedic trauma patient. Can J Psychiatry 2003;48:131–2.
42.Trendelenburg, G, Heinz, A, Strohle, A. Gamma-hydroxybutyrate dependence with social phobia. Am J Psychiatry 2004;161:375–6.
43.Hoes, MJ, Vree, TB, Guelen, PJ. Gamma-hydroxybutyric acid as hypnotic: clinical and pharmacokinetic evaluation of gamma-hydroxybutyric acid as hypnotic in man. Encephale 1980;6:93–9.
44.Wong, CGT, Chan, KFY, Gibson, KM, et al. Gamma-hydroxybutyric acid: neurobiology and toxicology of a recreational drug. Toxicol Rev 2004;23:3–20.
45.Snead, OC III, Gibson, KM. Gamma-hydroxybutyric acid. N Engl J Med 2005;352:2721–32.
46.Rang, HP, Dale, MM, Ritter, JM. Anxiolytic and hypnotic drugs. In: Pharmacology. 4th ed. Edinburgh (UK): Churchill Livingstone; 1999. p 531–2.
47.McDonough, M, Kennedy, N, Glasper, A, et al. Clinical features and management of gamma-hydroxybutyrate (GHB) withdrawal: a review. Drug Alcohol Depend 2004;75:3–9.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *

CAPTCHA *

Skip to the audio challenge
×

Keywords:

Metrics

Full text views

Total number of HTML views: 1
Total number of PDF views: 129 *
Loading metrics...

Abstract views

Total abstract views: 335 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 13th June 2018. This data will be updated every 24 hours.

Cancel
Confirm
×