Some chemical compounds possess sedative-hypnotic properties but were marketed as health food products and until recently escaped Food and Drug Administration (FDA) regulation. Among these drugs, gamma-hydroxybutyrate (GHB) is gaining notoriety as a product to illicitly inflict the harm of involuntary intoxication or chemical submission, commonly referred to as "date rape." GHB has no legitimate clinical purpose in the United States and is being cited increasingly as a toxic and dangerous agent. Despite this irony, it remains readily available via recipes on the Internet and stovetop component mixes by mail order. Certainly, patients presenting with complaints of drug-induced physical and sexual assault will pose novel diagnostic, medical, and legal problems to challenge emergency physicians.1
Agents in this chapter share certain pharmacologic and clinical similarities. These drugs tend to be highly lipophilic and concentrate in the central nervous system (CNS), causing varying degrees of CNS depression with gradual redistribution and eventual hepatic degradation. Clinically, mild intoxication manifests as sedation and incoordination that progresses to lethargy, worsening ataxia, and deepening coma in overdose.
It is recognized that reaching a treatment center predicts a favorable outcome in all types of nonbenzodiazepine sedative-hypnotic overdoses. Improvements in general supportive care underpin declining trends seen in mortality associated with these agents over broad dose ranges. Therefore, general treatment guidelines take precedence in management of all these agents in overdose.
This chapter reviews current drugs implicated and reported as toxic exposures of the nonbenzodiazepine sedative-hypnotic variety. Departures from general clinical presentation, complications, and management of overdose unique to a specific agent correspondingly will be highlighted in the discussion of that agent.
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