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Paroxysmal sympathetic surge associated with gamma hydroxybutyrate
Matthew J Reed1, Gareth R Clegg
1Department of Emergency Medicine, Royal Infirmary of Edinburgh, UK. mattreed1@hotmail.com
Summary
Recreational gamma hydroxybutyrate (GHB) use is rising. This case report details a GHB overdose linked to paroxysmal sympathetic storm, a condition typically seen after brain injuries.
Area of Science:
- Toxicology
- Neurology
- Emergency Medicine
Background:
- Gamma hydroxybutyrate (GHB) is a central nervous system depressant increasingly used recreationally.
- GHB overdose is a growing public health concern, particularly in the United Kingdom.
- Paroxysmal sympathetic storm (PSS) is a rare condition characterized by autonomic dysregulation, typically associated with severe brain injury.
Observation:
- A case of GHB overdose presenting with PSS is described.
- The patient exhibited signs of autonomic hyperactivity, including hypertension, tachycardia, and hyperthermia.
- This presentation mimicked PSS in patients with traumatic brain injury.
Findings:
- GHB overdose can precipitate PSS, a previously unrecognized association.
- The mechanism may involve direct effects of GHB on central autonomic pathways.
- This highlights the complex neurological sequelae of recreational GHB intoxication.
Implications:
- Clinicians should consider GHB toxicity in patients presenting with PSS, even without a history of head trauma.
- Early recognition and management of GHB-induced PSS are crucial for patient outcomes.
- This case broadens the differential diagnosis for PSS and emphasizes the neurotoxic potential of recreational GHB.
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