YHydroxy Butyrate

Y-hydroxy butyrate (GHB) is a naturally occurring substance in the human brain structurally related to GABA that may be a neurotransmitter (100). It has been used as an anesthetic (although it has little analgesic effect), to alleviate narcolepsy, and to treat alcohol and opiate dependence (101). There have been reports of abuse in the United Kingdom and United States within the dance scene and gay clubs and with body builders because it is said to promote slow-wave sleep during which growth hormone is secreted (102). It is available as a colorless, odorless liquid, powder, or a capsule to be taken orally; it is rarely injected. GHB is rapidly absorbed, with peak plasma concentrations occurring 20-45 minutes after oral administration. It has a half-life of 30 minutes (103), and effects can last from 45 minutes to 8 h (104).

Initial effects include euphoria followed by profound sedation, confusion, agitation, amnesia, nausea, vomiting, diarrhea, ataxia, seizures, hypoto-nia, tremor, vertigo and dizziness, bradycardia, hypotension, hypothermia, coma (105), and respiratory collapse.

There is a narrow margin between intoxication and coma (106), and the clinical effects are potentiated by use of other CNS depressant drugs, such as alcohol, opiates, benzodiazepines, and neuroleptics (107). Tolerance and physical dependence after high-dose use can develop with a withdrawal syndrome, which may include insomnia, muscular cramping, tremor, and anxiety (101). Symptoms of withdrawal from GHB are broadly similar to those for alcohol although of a more rapid onset. A rapid deterioration into delirium may occur in more frequent high-dose dependent users. Withdrawal is not associated with seizures, but if suspected, hospital admission should be considered (108).

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