Gamma-hydroxybutyrate: a 30 month emergency department review

To describe epidemiology, symptomatology, resource use and complications in patients attending the ED following gamma-hydroxybutyrate (GHB) ingestion.

Retrospective chart review of GHB-related emergency attendances over 30 months.

One hundred and seventy emergency attendances attributed to GHB ingestion occurred. Monthly attendance rate doubled during the study, and was highest on public holidays and weekends between 04.00 and 08.00 hours. The majority (63%, 95% CI 55.7-70.3) were young men (median 22 years). GHB was ingested alone in 62 cases (36%, 95% CI 29.6-43.9). Poly-substance ingestion was common (108 cases; 64%; 95% CI 56.1-70.4). The commonest presenting symptom was altered conscious state (89%, 95% CI 84.1-93.5) with 54% (95% CI 46.6-61.6) having low Glasgow Coma Score (GCS 3-8) on arrival at the ED. Eight per cent (95% CI 3.6-11.6) were intubated. Eighty-seven per cent (95% CI 79.8-93.8) with low GCS were not intubated. There were no serious adverse outcomes or fatalities. Recovery time from ED arrival to high GCS (9-15) was rapid (median 76 min, interquartile range 80). Overall median length of stay was 199 min (interquartile range 162).

This is the largest GHB-related case series to date. Attendance rate doubled during the study, and peaked at times of lowest staffing. Poly-substance ingestion is common. Attendances are of high acuity with decreased conscious state and airway threat. With close conservative management, most recover quickly without adverse sequelae.