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Gamma butyrolactone (GBL), gamma hydroxybutyrate (GHB), and 1,4-butanediol are known as "liquid ecstasy", a family of synthetic compounds with a substantial potential of abuse for their purported effects as euphoriants, natural psychedelics, muscle builders, fat metabolisers, sexual performance enhancers, and chemical submission drugs. In the past decade, they have been largely marketed as dietary supplements. 1- 3 GBL is also used as a chemical intermediate, a solvent for polymers, in paint or glue removers, and in drilling oils. After rapid absorption, GBL is converted to GHB and then to GABA (gamma aminobutyric acid) in situ, 4 which exhibits a narcotic effect on the central nervous system (CNS). CNS clinical effects also include euphoria, headache, dizziness, ataxia, confusion, amnesia, hypotonia, hallucinations, loss of peripheral vision, somnolence, unconsciousness, or coma. Gastrointestinal effects can include excessive salivation and vomiting. Metabolic acidosis is often reported, as is hypothermia (35°C or less). Reported cardiovascular effects include bradycardia, hypotension, right bundle branch block, and ST segment elevation. Of interest, described respiratory effects are limited to ventilatory depression or Cheyne-Stokes respiration. 1, 5 Respiratory acidosis and apnoeic episodes may also occur.
CASE REPORT
A 4 year old healthy child became unresponsive a few minutes after drinking a chemical compound containing GBL (Destak, marketed as paint remover solvent). On parental examination, he did not respond to vocal and deep painful stimulation. A progressive shortness of breath developed, causing cyanosis and eventually respiratory failure. In the emergency department, his heart rate was 100 beats/min, arterial blood pressure was 100/50 mm Hg, peripheral pulses were palpable, and temperature was 36°C. Respiratory rate was 32 breaths/min, but oxygen saturation on room air fell to 79%; he was intubated and transferred to the paediatric intensive care unit (PICU). Admitting laboratory findings were unremarkable except for a moderate hyperglycaemia (glucose 175 mg/dl) and lactate dehydrogenase elevation (531 UI); urine glucose was 0.5 g/dl. Complete...