Severe gamma-hydroxybutyrate withdrawal: A case report and literature review

We report a case of gamma-hydroxybutyrate (GHB) withdrawal resulting in sev ere agitation, mental status changes, elevated blood pressure, and tachycar dia hours after stopping chronic use of GHB, The patient admitted to substa ntial GHB abuse on a daily basis for 2.5 years. Previous attempts at cessat ion reportedly resulted in diaphoresis, tremors, and agitation. The patient 's symptoms, negative polypharmacy history, and negative urine and blood to xicological analysis for alcohol, benzodiazepines, sedative-hypnotics, or o ther substances suggested the diagnosis of GHB withdrawal. Later analysis o f a patient drug sample confirmed the presence of GHB, The patient required 507 mg of lorazepam and 120 mg of diazepam over 90 h to control agitation, This is one of the few reported cases of GHB withdrawal and one of the mos t severe. Given the increasing use of GHB, more cases of severe GHB withdra wal should be anticipated. (C) 2000 Elsevier Science Inc.