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Pediatric gamma hydroxybutyrate intoxication
S Suner1, C S Szlatenyi, R Y Wang
1Brown University School of Medicine, Providence, RI, USA. selim_suner@brown.edu
Insights
Two children experienced gamma hydroxybutyrate (GHB) toxicity after ingesting a homemade drink. This highlights the dangers of clandestine GHB production and its potential presence in households.
Area of Science:
- Toxicology
- Pediatric Medicine
- Forensic Chemistry
Background:
- Gamma hydroxybutyrate (GHB) is a central nervous system depressant.
- Clandestine synthesis of GHB poses significant public health risks.
- Accidental pediatric exposure to GHB is uncommon but dangerous.
Observation:
- Two children presented with sudden onset coma after unintentional ingestion of a GHB-containing beverage.
- The GHB was synthesized at home by a parent using gamma-butyrolactone and sodium hydroxide.
- Clinical presentation included rapid onset of symptoms and resolution within 24 hours.
Findings:
- Electrocardiogram (ECG) abnormalities were observed in one child, unique to GHB toxicity and currently unexplained.
- Pediatric GHB toxicity mirrors clinical manifestations seen in adult cases.
- Standard drug screening assays do not detect GHB.
Implications:
- Healthcare providers must be aware of the clandestine production and increasing availability of GHB.
- Prompt recognition and supportive care are crucial for managing pediatric GHB toxicity.
- The potential for household synthesis necessitates increased vigilance regarding substance safety.
Abstract:
Reported are 2 uncommon cases of childhood gamma hydroxybutyrate (GHB) toxicity and the surreptitious manner in which GHB was made. Two children unintentionally ingested a soft drink containing GHB and were found comatose. Both had been well 1 hour earlier. The parent had made GHB by combining gamma butyrolactone with caustic soda (sodium hydroxide). Symptoms were early in onset and resolved in 24 hours. The ECG changes in one case are unique to GHB toxicity and are unexplained. GHB-toxic children appear similar to adults who have this poisoning. Supportive management remains the mainstay of therapy. Health care providers should be aware of GHB's clandestine production and its increasing presence on the streets and in the home. This agent is not detected with common drug screens.