Case 7 – A Bad Drink

Case #7: A Bad Drink
Author: Michael Gottlieb, MD
Peer Reviewer: Steve Aks, MD

A 19 year old female is brought to the ED by her friends after she suddenly passed out at a party. She has no past medical history, does not take any medications, and felt fine prior to losing consciousness, with no prodromal symptoms. On examination there is no evident trauma and her pupils are equal, round, and reactive. The remainder of her exam is non-focal.

Vitals: Temp: 98.0, HR: 74, RR: 8, BP: 108/74, O2 sat: 93% on RA

The patient was intubated secondary to concern for airway protection. Two hours later, she is wide awake and is rapidly extubated.

What is the most likely toxicologic etiology of this patient’s presentation?
If GHB is the responsible drug, what other clinical symptoms might you expect to see with this patient?
What further work-up is required?
What is the disposition of these patients?

References:

Drasbek KR, Christensen J, Jensen K. Gamma-hydroxybutyrate—a drug of abuse. Acta Neurol Scand. 2006 Sep;114(3):145-56.

Li J, Stokes SA, Woeckener A. A tale of novel intoxication: seven cases of gamma-hydroxybutyric acid overdose. Ann Emerg Med. 1998 Jun;31(6):723-8.

Li J, Stokes SA, Woeckener A. A tale of novel intoxication: a review of the effects of -hydroxybutyric acid with recommendations for management. Ann Emerg Med. 1998 Jun;31(6):729-36.

Mason PE, Kerns WP 2nd. Gamma hydroxybutyric acid (GHB) intoxication. Acad Emerg Med. 2002 Jul;9(7):730-9.

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 Mar;29(3):319-32.

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