This document provides information on gamma-hydroxybutyric acid (GHB) for emergency nurses. It discusses GHB's street names, pharmacology, clinical presentation, management, and risks. GHB is a depressant most commonly used illegally as a date rape drug or at raves due to its euphoric effects. It often causes coma, respiratory depression, vomiting, and other issues requiring supportive care and monitoring in the emergency department. Multiple patients presenting with GHB intoxication may temporarily overwhelm hospital resources.

1. What the emergency nurse need’s to know about
GHB?

2. GHB Culture
 Popular @rave parties for
euphoric effects
 Bodybuilder Supplement
(growth hormone)
 Sleep Aid
 Tried as an anaesthetic
agent
 Used as date rape drug
 Tried as Tx for
narcolepsy, ETOH
withdrawal

3. Street Names (What the cool people call it!!!)
 GBH (grievous bodily harm)
 Liquid ecstasy
 Fantasy
 Cherry Meth
 G
 Georgia home boy
 Goop
 Salty water
 Scoob
 SCGH Alcohol & Drug Liaison Project

4. Is it in WA
 We tend to be the virgin state.
 Popular on the east coast during rave’s
 Popular in the media
 Move raves/festivals each year in Perth

5. What is it?
 Colourless
 Odourless
 Bitter tasting liquid
 Can also be powder

6. Pharmacology
 Gamma hydroxybutytric acid
 Crosses blood-brain barrier
 CNS depressant that's abused for its ability to induce
euphoria, hypnosis, and amnesia.
 Toxicity occurs from depressant effects (cns/resp)

7. Pathophysiology
The GHB Clinical Syndrome generally presents with:
1. CNS depression
2. Nystagmus
3. Respiratory depression
4. Miosis
5. Myoclonus
6. Vomiting
 Patient typically present’s with coma, resp depression,
mild bradycardia, and vomiting.

8. Differential Dx:
 Look @ what else can cause:
 COMA, SEIZURES, RESP depression/arrest
 Hypoglycaemia
 Opiate OD, Ketamine OD
 SAH
 CVA
 CNS Lesion
 Infection

9. Clinical Features
Cardio: Resp:
 Bradycardia Depression
 Hypotension Apnoea
 Hypertension Aspiration
 ECG Changes Cheyne-stokes
Gastro:
 Nausea
 Vomiting
 Caustic Burns

10. Clinical Features
Neuro: Metabolic:
 CNS depression Resp Acidosis
 Coma Metabolic Acidosis
 Myoclonus Hypernatreamia
 Seizures Hypokalaemia
 Miosis Hyperglycaemia
 Ataxia
 Agitation
 Euphoria
 Amnesia
 Dizziness
 EPS

11. Investigations
Tox Screen:
 12 lead ECG
 BSL
 Paracetamol level
 Temp

12. Acute Management
 Management is supportive of ABC
 Airway
 Breathing
 Circulation
1. Tx: bradycardia with atropine
2. Hypotension responds fluid challenge
 Disability
1. Can be combative, need restraints, ?sedation
2. Decreasing GCS = Intubate
3. ?? Use of Physostigmine
 Exposure
1. Other drugs on board (commonly ETOH, Amphetamines)
2. Other toxidromes

13. Decontamination
 AC not clinically useful as onset CNS depression
occurs rapidly
Enhanced Elimination:
 Not clinically uselful
 (Toxicology handbook, 2007, p201)

14. Antidotes
 Physostigmine has been used and proposed as
antidote for GHB
 Poor safety profile in GHB

15. Withdrawal
 GHB very addictive
 Need frequent ingestions to WD

16. Withdrawal Mx
 Supportive Care
 Benzo’s (Diazepam)
 Phenothiazines (Olanzapine)

17. Prehospital Presentations
 Victorian study looked @ ambulance related attendances
for GHB Vs Heroin
 Retrospective analysis from Mar 01- Oct 05.
 Dietze, P.(2008). Patterns and incidences of y-
hydroxybutyrate (GHB)-related ambulance attendances in
Melbourne, Victoria. MJA, 188(12), 709-711

19. Presentations to ED

20. The Gold Coast Experience
 Harraway, T., & Stephenson, L.(1999). Gamma
hydroxbutyrate intoxication: The Gold Coast
experience. Emergency Medicine, 11, 45-48

21. Kiddies stuff

22. Fatalities
 Australasia study Jan 2000 – Aug 2003.
 10 confirmed GHB Deaths
 Caldicott, D, Et al.(2004).Fatalities associated with the use of y-
hydroxybutyrate and its analogues in Australasia. MJA, 18(6), 310-313.

23. Drink spiking!!
 Has been reported as date rape drug!

24. Disaster Preparedness
 Multiple pts presenting in short period of time
 Often present 0400-0800 (decreased staffing)
 Need for multiple ventilators
 Need to call in staff
 Arrange ICU beds

25. References
 Caldicott, D, Et al.(2004).Fatalities associated with the
use of y-hydroxybutyrate and its analogues in
Australasia. MJA, 18(6), 310-313
 Dietze, P.(2008). Patterns and incidences of y-
hydroxybutyrate (GHB)-related ambulance
attendances in Melbourne, Victoria. MJA, 188(12), 709-
711
 Harraway, T., & Stephenson, L.(1999). Gamma
hydroxybutyrate intoxication: The Gold Coast
experience. Emergency Medicine, 11, 45-48

26. The End