A case of massive gamma-hydroxybutyrate overdose mimicking brain death

A 36-year-old female was brought into hospital following a massive overdose of 100 ml of gamma-hydroxybutyrate. Unlike prior case reports where ethanol was a co-ingestant with gamma-hydroxybutyrate or its precursor, gamma-hydroxybutyrate was believed to have been the only substance ingested in this case. The patient developed a severe and persistent high anion gap metabolic acidosis and required continuous renal replacement therapy. The patient developed fixed and dilated pupils early on in her clinical course and was found to have a transient loss of most brainstem reflexes on clinical examination, thus mimicking brain death. She also developed generalised tonic-clonic seizures and received midazolam and levetiracetam for seizure control. She was successfully extubated after 5 days on mechanical ventilation and was discharged home on day 11 with no neurological deficits.