ToxicologyEmergency
GHB / GBL overdose
Rapid-onset coma and bradycardia from gamma-hydroxybutyrate / gamma-butyrolactone; supportive airway care and recognition of withdrawal.
Source: TOXBASE/NPIS; AACT/EAPCCT; BNF
Step 1 of ~7
action
Recognise the toxidrome
GHB and its prodrugs GBL and 1,4-BD are commonly used recreationally (chemsex) or as date-rape agents. Onset 15 min, peak ~1 h, duration 2–4 h.
Features: rapid-onset coma (often GCS 3 with airway loss), bradycardia, mild hypothermia, hypotension, miosis or mydriasis, paradoxical agitation on stimulation. Vomiting + apnoea risk. Co-ingestion (alcohol, methamphetamine, sildenafil, MDMA) very common.
ABCDE; lateral position; high-flow O₂; continuous monitoring; bloods inc. paracetamol/salicylate, alcohol, glucose, VBG, U&E, CK, ECG.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- DiazepamRecommendedBenzodiazepine (long-acting)
- LorazepamRecommendedBenzodiazepine
- MidazolamRecommendedBenzodiazepine
Same class
Pathways
- Paracetamol overdose · TOXBASE/NPIS; MHRA DSU 2012/2024; SNAP regimen (Lancet 2014); BNF
- TCA overdose · TOXBASE/NPIS; AACT/EAPCCT position statements; Resuscitation Council UK ALS
- Opioid overdose · TOXBASE/NPIS; Resuscitation Council UK; BNF
- Anticholinergic toxidrome · TOXBASE/NPIS; AACT/EAPCCT; BNF
- Benzodiazepine overdose · TOXBASE/NPIS; AACT/EAPCCT; BNF
- β-blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
Decision support only. Always apply local guidelines and clinical judgement.