Citation

McIntosh BW, Mayeux C. BMJ Case Rep. 2024; 17(5): e260025.

Copyright

(Copyright © 2024, BMJ Publishing Group)

DOI

10.1136/bcr-2024-260025

PMID

38821567

Abstract

While typically thought of as an illicit substance, oxybate salts or gamma-hydroxybutyrate (GHB) has more recently been prescribed to treat narcolepsy by enhancing night-time sleep resulting in decreased daytime drowsiness. This case involves a college-aged female with prescribed GHB for narcolepsy who took her second nightly dose too early. This resulted in mental depression, respiratory failure, intubation and mechanical ventilation. The patient was successfully extubated in the intensive care unit several hours later with no residual morbidity. We were unable to identify any prior reports of mixed-salt oxybate toxicity following mistimed drug administration. This case should serve as a warning to emergency physicians to be on the lookout for GHB as part of the differential diagnosis for patients with narcolepsy presenting with altered mental status. It should also serve as a warning to patients and prescribers that this medication can have outcomes that require immediate medical intervention.

Language: en

Keywords

Humans; Female; Safety; Toxicology; Magnesium; *Drug Overdose; *Narcolepsy/drug therapy/diagnosis; *Respiration, Artificial; *Respiratory Insufficiency/chemically induced/therapy; *Sodium Oxybate/poisoning/adverse effects; Contraindications and precautions; Medication Errors; Potassium/blood/therapeutic use; Sleep disorders (neurology); Unwanted effects / adverse reactions