A 28-year-old bodybuilder who has been taking gamma-hydroxybutyrate nightly for sleep abruptly stops the drug. Within 12 hours he develops severe agitation, delirium, profuse sweating, tachycardia, hypertension, and tremulousness, progressing despite routine doses of diazepam. Compared with typical sedative-hypnotic withdrawal, what distinguishes this presentation?
- A It has a benign self-limiting course requiring only reassurance
- B It responds specifically to flumazenil infusion
- C It can be rapidly fatal and often needs high-dose benzodiazepines or baclofen ✓
- D It characteristically spares autonomic function
Correct answer: C. It can be rapidly fatal and often needs high-dose benzodiazepines or baclofen
Explanation
GHB withdrawal is one of the few non-alcohol sedative withdrawals that can be life-threatening. Because GHB has a very short half-life, symptoms begin within hours and include delirium, autonomic instability, and refractory agitation; deaths from hyperthermia and rhabdomyolysis are reported. Management frequently requires high-dose benzodiazepines, sometimes with baclofen. Flumazenil is not an established treatment and risks seizures. Autonomic involvement is prominent, making option D false.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.