GHB – informing clinical practice by Dr Jonathan Karro

Posted on July 11, 2019

Dr Jonathan Karro is an Emergency Physician and Clinical Toxicologist. He is Clinical Director of Emergency Medicine at St Vincent’s Hospital Melbourne and Honorary Senior Lecturer at the University of Melbourne. Jonathan completed a Sabbatical and Masters in Clinical Toxicology in 2012 working with the Victorian Poisons Information Centre and Austin Toxicology Service. His most significant area of toxicology research has been in the optimal sedation of the agitated/behaviourally disturbed ED patient.  

Author Quotes: 

(…) Worldwide, certainly in Australia, it’s the same times – it’s weekends in that 4 am till 8 am period of time that we see the vast majority of these presentations, and Monday public holidays are also a very common time.

Patients when they arrive, they are really sick. You don’t get a higher category than an Australian triage category of 1 – other things that qualify are cardiac arrest, profound coma in this stage, or severe agitation, and most patients arrive (around about half) with a profound alteration in their conscious state. But, we only need to incubate a really small percentage of these patients.

If you get to an emergency department alive, you do not die from GHB. So, one of the messages for people is that if you do into trouble is certainly to seek medical care. In a number of these deaths, people left to sleep it off – having a nap or ‘g-ing out’ – were subsequently found by people to have died.

Summary and slides:  

Dr Karro begins this second part of his presentation with a look at the literature and how various studies have influenced clinical practice. 

He presents data from published studies which resulted in the need to intubate patients being removed from the procedure within certain caveats and reviews the available mortality data. 

He moves on to discuss the numbers associated with GHB-related death internationally and stresses how seeking medical care is the difference between life and death. 

Dr Karro describes the emerging problem of drug dependency and withdrawal, where people are taking multiple doses of GHB daily. He discusses how there are no real antidotes to toxicity and limited options for treating withdrawal syndrome.  Dr Karro ends his presentation with a summary of the main points and a Q&A session with the audience. 

Take Home Points: 

  • Most patients presenting to the emergency department are ready to go home in three to four hours and are a relatively easy cohort of patients to manage. 
  • The vast majority of GHB-related deaths (the UK, US & Canada) are from cardio-respiratory arrest. 
  • There may be an association between recurrent GHB-related coma and persistent memory problems. 
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