II. Pathophysiology

  1. GHB Dependence is rare due to rapid elimination
  2. GHB Dependence may occur with excessive use
    1. Frequent dosing (q1-3 hours around the clock)
    2. Chronic use

III. Symptoms: Withdrawal

  1. Early symptoms
    1. Insomnia
    2. Tremor
    3. Anxiety
    4. Confusion
    5. Nausea and Vomiting
  2. Later symptoms
    1. Agitation
    2. Vivid Hallucinations
    3. Combative behavior
    4. Disorientation
  3. Associated Symptoms: Autonomic Instability
    1. Tachycardia
    2. Hypertension
    3. Tremor
    4. Diaphoresis

V. Labs

VI. Management

  1. Agitation may require restraints
    1. Four point Physical Restraints
    2. See also Chemical Restraints
  2. Symptomatic management
  3. Sedation
    1. Benzodiazepine
    2. Barbiturate

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