Background: Gamma-butyrolactone (GBL), a chemical in many solvents that is metabolized into gamma-hydroxybutyrate (GHB) which acts as a precursor to gamma-aminobutyric acid in the Central Nervous System, which is known for its calming effect leading to unconsciousness and coma making it popular in the drug-abusing scene, such cases reported in the country are limited, leading to weak understanding of a patients’ presentation.
Case Presentation: A 21-year-old male patient presented by ambulance to the emergency department of a Tertiary Hospital in Saudi Arabia after being found unconscious due to GBL and methamphetamine (MA) ingestion which was obtained from Gel-removers. The patient was unconscious with bilateral pinpoint pupils, sinus bradycardia, and bradypnea. Initial intervention with atropine and naloxone intravenous improved the heart rate without respiratory rate or mental state improvement. Agitation and confusion were noted, thus midazolam was administered and brain CT was done to rule out intracranial pathologies which were negative. Another naloxone dose was administered after an hour due to the development of snoring and posterior displacement of the tongue with no improvement, intubation was done and maintenance sedation started. After 1.5 hours the patient woke up agitated and sedation was discontinued, he was hemodynamically stable and gradually gained full consciousness. It was revealed that the patient had been abusing a GBL-containing substance and MA, which accounted for the clinical presentation and progression of symptoms.
Conclusion: Due to the rise of GBL/GHB intoxication cases, further literature must be established and more cases should be reported to raise awareness regarding this substance.
Key words: Gamma-Butyrolactone (GBL), methamphetamine abuse, multi-gel remover, neurotoxicity, substance abuse.
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