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Case series of 226 γ-hydroxybutyrate-associated deaths: lethal toxicity and trauma.
Am J Emerg Med. 2011 Mar; 29(3):319-32.AJ

Abstract

γ-Hydroxybutyrate (GHB) and its prodrugs are drugs of abuse that were also sold as "dietary supplements." Users present to emergency departments with overdose, impaired driving, withdrawal, and associated trauma. We compiled a series of GHB-associated deaths to elucidate lethal risks, GHB concentrations, cointoxicants, products, uses, and medical interventions. Death records were reviewed for toxicology, autopsy findings, and history. Inclusion cutoffs were as follows: 5/10 mg/L of GHB (antemortem blood/urine) and 50/20/7 mg/L of GHB (postmortem blood/urine/vitreous). Of 226 deaths included, 213 had cardiorespiratory arrest and 13 had fatal accidents. Seventy-eight deaths (35%) had no cointoxicants. Sixteen deaths involved "supplements" and 1 involved pharmaceutical GHB (Xyrem, Jazz Pharmaceuticals, Palo Alto, CA). Postmortem blood GHB was 18 to 4400 mg/L (median, 347 mg/L) in deaths negative for cointoxicants. Cardiorespiratory arrest occurred prehospital in 100% of 184 cases with available history. Of 72 cases with antemortem adverse effects reported, medical assistance was delayed or absent in 66; of these, acute GHB ingestion was known in 51, including 40 left to "sleep off" adverse effects. Thirty others were left "sleeping" and found dead. γ-Hydroxybutyrate is lethal even without cointoxicants, directly and through fatal accidents. Medical interventions were frequently delayed or absent despite known GHB ingestion, and witnessed adverse events and cardiorespiratory arrest occurred prehospital. Education is needed about the lethality of GHB and the necessity for prompt medical intervention.

Authors+Show Affiliations

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA. dzvosec@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20825811

Citation

Zvosec, Deborah L., et al. "Case Series of 226 Γ-hydroxybutyrate-associated Deaths: Lethal Toxicity and Trauma." The American Journal of Emergency Medicine, vol. 29, no. 3, 2011, pp. 319-32.
Zvosec DL, Smith SW, Porrata T, et al. Case series of 226 γ-hydroxybutyrate-associated deaths: lethal toxicity and trauma. Am J Emerg Med. 2011;29(3):319-32.
Zvosec, D. L., Smith, S. W., Porrata, T., Strobl, A. Q., & Dyer, J. E. (2011). Case series of 226 γ-hydroxybutyrate-associated deaths: lethal toxicity and trauma. The American Journal of Emergency Medicine, 29(3), 319-32. https://doi.org/10.1016/j.ajem.2009.11.008
Zvosec DL, et al. Case Series of 226 Γ-hydroxybutyrate-associated Deaths: Lethal Toxicity and Trauma. Am J Emerg Med. 2011;29(3):319-32. PubMed PMID: 20825811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case series of 226 γ-hydroxybutyrate-associated deaths: lethal toxicity and trauma. AU - Zvosec,Deborah L, AU - Smith,Stephen W, AU - Porrata,Trinka, AU - Strobl,A Quinn, AU - Dyer,Jo Ellen, Y1 - 2010/04/28/ PY - 2009/09/23/received PY - 2009/11/05/revised PY - 2009/11/07/accepted PY - 2010/9/10/entrez PY - 2010/9/10/pubmed PY - 2011/4/16/medline SP - 319 EP - 32 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 29 IS - 3 N2 - γ-Hydroxybutyrate (GHB) and its prodrugs are drugs of abuse that were also sold as "dietary supplements." Users present to emergency departments with overdose, impaired driving, withdrawal, and associated trauma. We compiled a series of GHB-associated deaths to elucidate lethal risks, GHB concentrations, cointoxicants, products, uses, and medical interventions. Death records were reviewed for toxicology, autopsy findings, and history. Inclusion cutoffs were as follows: 5/10 mg/L of GHB (antemortem blood/urine) and 50/20/7 mg/L of GHB (postmortem blood/urine/vitreous). Of 226 deaths included, 213 had cardiorespiratory arrest and 13 had fatal accidents. Seventy-eight deaths (35%) had no cointoxicants. Sixteen deaths involved "supplements" and 1 involved pharmaceutical GHB (Xyrem, Jazz Pharmaceuticals, Palo Alto, CA). Postmortem blood GHB was 18 to 4400 mg/L (median, 347 mg/L) in deaths negative for cointoxicants. Cardiorespiratory arrest occurred prehospital in 100% of 184 cases with available history. Of 72 cases with antemortem adverse effects reported, medical assistance was delayed or absent in 66; of these, acute GHB ingestion was known in 51, including 40 left to "sleep off" adverse effects. Thirty others were left "sleeping" and found dead. γ-Hydroxybutyrate is lethal even without cointoxicants, directly and through fatal accidents. Medical interventions were frequently delayed or absent despite known GHB ingestion, and witnessed adverse events and cardiorespiratory arrest occurred prehospital. Education is needed about the lethality of GHB and the necessity for prompt medical intervention. SN - 1532-8171 UR - https://wwww.unboundmedicine.com/medline/citation/20825811/Case_series_of_226_γ_hydroxybutyrate_associated_deaths:_lethal_toxicity_and_trauma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(09)00553-1 DB - PRIME DP - Unbound Medicine ER -