GHB is also called as "liquid ecstasy," this cheaper club drug can be most dangerous when mixed with alcohol. Here's how to support a patient who's overdosed.

ara Walters, 23, is brought to your emergency department (ED) after she collapsed at a nightclub. The paramedics report that when they arrived on the scene, Ms. Walters was unconscious and her vital signs were: BP 118/64; pulse, 64; respirations, 10; and temperature, 950 F (350 C)-mildly hypothermic.

Although the paramedics gave her 4 mg of intravenous (LV) naloxone during transport, she's still unresponsive, indicating that a narcotic overdose isn't a factor. Her friends told the paramedics that Ms. Walters had been drinking alcohol and something called liquid X, which you recognize as a street name for gammahydroxybutyrate (GHB), also called liquid ecstasy. Like the street drug known as ecstasy, an amphetamine, GHB enhances sensitivity to touch and reduces inhibitions. Her pupils are 4 mm and brisk to react, and her gag reflex is severely depressed. She's intubated to protect her airway You start a second IN line and obtain specimens for a complete blood cell (CBC) count, electrolytes, blood glucose level, blood urea nitrogen level, blood alcohol level, thyroid stimu

lating hormone, serum creatine kinase, and urine drug screen. Start an infusion of 0.9% sodium chloride solution with 100 mg of thiamine (because alcohol depletes thiamine stores).

Lab results reflect an alcohol level of 135 mg/dl (or 0.135%; greater than 0.08% is considered intoxicated under the law), and the urine drug screen is positive for marijuana. The other results are normal and the patient shows no signs of trauma.

An hour after arrival, Ms. Walters begins to move her extremities and exhibits some purposeful movement. After 3 hours, she's alert enough to be extubated. Before discharge, she says that she's taken liquid X before, but in smaller amounts. Designer danger Liquid X, Georgia homeboy, liquid ecstasy, everclear, renutrient, and g-riffick are just a few of the names for GHB, a central nervous system (CNS) depressant thats become a popular party drug because of its inhibition-lowering effects.

First used as an anesthetic in the 1960s, GHB later was used as a bodybuilding supplement because of its alleged anabolic effects. In the last 10 years, it's become a recreational drug, available as a powder for snorting or smoking and as a liquid for drinking or adding to another drink. The highly concentrated liquid is usually sold in small plastic bottles for about $10. A bottle contains 9 or 10 "hits" of a capful each.

GHB also has become a new weapon in date rape because it reduces inhibitions, relaxes muscles, and causes amnesia. The odorless, colorless liquid has a slightly salty taste, which may be obscured when it's added to a beverage.