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Long-term Behavioral and Reproductive Consequences of Embryonic Exposure to Low-dose Toxicants
Published on: March 6, 2018
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1,4-Butanediol overdose mimicking toxic alcohol exposure
Maurizio Stefani1,2, Darren M Roberts1,2
1Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Sydney, Australia.
Clinical Toxicology (Philadelphia, Pa.)
|June 21, 2019
Summary
1,4-butanediol (1,4-BD) overdose mimics toxic alcohol poisoning, presenting with prolonged unconsciousness and metabolic acidosis. Early diagnosis via specific lab testing is crucial for effective management of this GHB analogue.
Area of Science:
- Toxicology
- Emergency Medicine
- Pharmacology
Background:
- 1,4-butanediol (1,4-BD) is a gamma-hydroxybutyrate (GHB) analogue increasingly implicated in recreational overdose.
- Confirmed 1,4-BD exposure reports are scarce, complicating clinical recognition and management.
Observation:
- A 44-year-old male presented with unconsciousness after ingesting a substance presumed to be GHB.
- Clinical features included prolonged unresponsiveness, high anion gap metabolic acidosis (HAGMA), and osmol gap, mimicking toxic alcohol poisoning.
- The patient received supportive care, including intubation, haemodiafiltration, and ethanol infusion, pending diagnosis.
Findings:
- Specific laboratory testing identified 1,4-BD as the causative agent, with the highest reported concentration in literature.
- 1,4-BD overdose can present with HAGMA and other signs typical of toxic alcohol ingestion.
- Ethanol co-ingestion delays the psychoactive effects of 1,4-BD's metabolite, GHB, due to competitive metabolism.
Implications:
- This case underscores the importance of considering 1,4-BD in overdose presentations mimicking toxic alcohol poisoning.
- Accurate diagnosis requires specific laboratory analysis to differentiate 1,4-BD from other toxic ingestions.
- Understanding 1,4-BD's unique pharmacokinetics, including ethanol interactions, is vital for appropriate clinical management.
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