GHB and DFSA: Lessons from a Real-World Emergency Case

Help clinicians navigate GHB toxicity through a detailed case breakdown, highlighting rapid-onset symptoms, treatment priorities, and forensic considerations.

PHARMACOLOGY/TOXICOLOGY CASE STUDY

History: A 20-year-old woman was brought to the emergency department by EMS after being found naked and disoriented in the street. She says she’d been at a party earlier but can’t remember anything after arriving there. She insists she didn’t intentionally take anything, and her memory is a complete blank about what happened.

PMH: None reported.

Physical Examination:

• T: 99.4°F
• HR: 65 bpm
• RR: 12 breaths per minute
• BP: 120/80 mm Hg
• General: She’s upset, crying, and restless, clearly shaken by the situation.
• HEENT: Nothing unusual—eyes, ears, and throat look normal.
• Pulmonary: Lungs sound clear when listened to.
• CV: Heartbeat’s a bit slow but steady, no odd sounds.
• Abdomen: Soft, no pain when pressed.
• Neurologic: Fully alert (GCS 15), cranial nerves check out fine—no obvious nerve damage.

QUESTIONS CASE STUDY #11

1. What’s the most likely thing she was exposed to?
2. What are the typical signs and symptoms tied to this kind of exposure?
3. What lab tests should we run?
4. What treatment does she need right now?

CASE STUDY #11: GHB EXPOSURE

1. Most Likely Exposure:
   This young woman’s story—blacking out after a party, waking up confused and unclothed—raises a big red flag for drug-facilitated sexual assault (DFSA). The top suspect here is gamma-hydroxybutyrate (GHB). It’s a sneaky one: a natural brain chemical that slips past the blood-brain barrier, knocks you out fast (15–20 minutes), wipes your memory, and clears out of your system quickly, making it tough to catch. That’s why it’s a go-to for predators.
2. Common Signs and Symptoms:
   GHB hits hard and fast. It’s like a sedative on steroids—think deep drowsiness or even coma, slow breathing, low blood pressure, a sluggish heart rate, and sometimes a drop in body temp. People usually snap out of it abruptly, but they’re left clueless about what happened. Most shake it off with supportive care, but in rare cases, it can spark agitation, seizures, or worse. The amnesia is the kicker—it’s why she can’t piece the night together.
3. Laboratory Tests:
   Here’s the catch: GHB won’t show up on your standard urine drug screen. If we need proof, we’re talking specialized tests like gas chromatography or mass spectrometry, but those take days or weeks—not helpful in the moment. For now, grab first-catch urine and blood ASAP, and lock them down with a proper chain of custody since this could be a crime scene case. Beyond that, run the basics for any overdose: a pregnancy test (she’s a young woman), an ECG to check her heart, a quick glucose check, and an acetaminophen level to rule out other sneaky culprits. Oh, and consider carbon monoxide, just in case—it can mimic some of this.
4. Treatment Required:
   First things first: make sure she’s breathing okay and her heart’s holding steady—airway, breathing, circulation, the whole drill. GHB often triggers vomiting, so we might need to protect her airway, maybe even intubate if she’s out of it. Beyond that, it’s all about support—keep her stable, calm her down, and let her body clear it out. She’ll also need the full rape kit and support offered to assault victims, given the circumstances. No fancy antidotes here—just good, solid care until she’s back on her feet.