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Notes from the May, 2000 Conference of the
California Association of Toxicologists

Page 9

3:30pm -- "Diagnosis and medical management of overdoses of GHB and related drugs."
Christine Haller, MD, California Poison Control Center, working at SF General
[View Presentation Handout - 650K]

A very interesting talk, she seemed sharp / bright and spoke well. She said she worked at San Francisco General Hospital for the statewide poison control system.

She said that GHB is, relatively speaking, a small drug of abuse. GHB is naturally occurring in the human body, a metabolite of GABA and a quasi neurotransmitter. She said that it is like a neurotransmitter and is created by cells as an intermediary step to store or transport GABA from one area to another. She said that GHB acts on the Gaba B receptors instead of the Gaba A like the benzos (valium).

She said that many of the GHB/GBL supplements are sold in colored liquids without child proof caps. She said that she thinks the colored liquids are "quite appealing to young people because of the bright colors". Unfortunately I didnt ask and she did not say whether she has actually seen any / many children come in for GHB poisoning.

She had a chart of the incidence of calls to the Poison Control center for the past 10 years which was quite interesting, with the number of calls at 356 for 1999 growing from 232 in 1998, 199 in 1997.

She said that she thinks that some GHB suffocations might be caused not only by vomit or gum or food or foreign material blocking the airway but by just the tongue falling back and blocking the airway by itself.

She said that it is not necessary to intubate GHB coma OD patients immediately, but instead monitor oxygen and CO2 levels and if the blood oxygen levels start to fall or or below normal, then intubate immediately. Patients need to be monitored constantly. I thought this particularly noteworthy because of the controversy that Porrata and others try to stir around the absolute need for full life support for any GHB OD / coma.

She said some people become combative as they awaken from GHB comas and that it was important not to sedate them and instead use soft restraints to keep the person from moving around too much and hurting themselves.

She said that she thinks that one of the least well reported problems with MDMA use is hyponatremia (low salt) which comes from drinking too much water (water intoxication). She said that the hyponatremia causes cerebral edema and that (some?) patients do not recover full function.

She also mentioned that permanent kidney damage was also a result of some MDMA use. I asked her about this afterwards and she said that kidney failure was one of the first problems associated with extreme overheating, and that with hyperthermia there also is muscle degradation and brain damage.

Someone asked whether the GHB comas cause brain damage and she answered "with GHB, if they don't suffer hypoxic damage from suffocation, they recover fully".