Figure 1
Chemical structures of GHB, GBL, and 1,4-BD
Figure 2
Synthesis of GABA from glutamate and metabolism into succinic semialdehyde or GHB (adapted from reference 37)
Table 1
Neurological symptoms of acute GHB poisoning
| Very common symptoms | Common symptoms | Less common symptoms |
|---|---|---|
| Ataxia, disorientation, dizziness, confusion, hallucinations, somnolence, slurred speech, myosis | Dysarthria, confusion, headache, incoordination, euphoria, amnesia, hypotonia, hyporeflexia, tremor, myoclonus, horizontal and vertical gaze nystagmus | Bruxism, vertigo, disinhibition, increased sexual arousal, delusions, extrapyramidal side effects, dystonias, athetosis, mydriasis |
Figure 3
Algorithm for the management of the withdrawal syndrome in patients abusing GHB and its precursors/analogues (adapted from reference 63)