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