Combination with alcohol In humans,<unk>  has been shown to reduce the elimination rate of alcohol. This may explain the respiratory arrest that has been reported after ingestion of both drugs. A review of the details of 194 deaths attributed to or related to<unk>  over a ten-year period found that most were from respiratory depression caused by interaction with alcohol or other drugs. Deaths One publication has investigated 226 deaths attributed to<unk> . Of 226 deaths included, 213 had a cardiorespiratory arrest and 13 had fatal accidents. 71 deaths (34%) had no co-intoxicants. Postmortem blood<unk>  was 18–4400 mg/L (median=347) in deaths negative for co-intoxicants. One report has suggested that sodium oxybate overdose might be fatal, based on deaths of three patients who had been prescribed the drug. However, for two of the three cases, post-mortem<unk>  concentrations were 141 and 110 mg/L, which is within the expected range of concentrations for<unk>  after death, and the third case was a patient with a history of intentional drug overdose. The toxicity of<unk>  has been an issue in criminal trials, as in the death of Felicia Tang, where the defense argued that death was due to<unk> , not murder.<unk>  is produced in the body in very small amounts, and blood levels may climb after death to levels in the range of 30–50 mg/L. Levels higher than this are found in<unk>  deaths. Levels lower than this may be due to<unk>  or to postmortem endogenous elevations. Neurotoxicity In multiple studies,<unk>  has been found to impair spatial memory, working memory, learning and memory in rats with chronic administration. These effects are associated with decreased NMDA receptor expression in the cerebral cortex and possibly other areas as well. In addition, the neurotoxicity appears to be caused by oxidative stress. Addiction Addiction occurs when repeated drug use disrupts the normal balance of brain circuits that control rewards, memory and cognition, ultimately leading to compulsive drug taking. Rats forced to consume massive doses of<unk>  will intermittently prefer<unk>  solution to water. Withdrawal<unk>  has also been associated with a withdrawal syndrome of insomnia, anxiety, and tremor that usually resolves within three to twenty-one days. The withdrawal syndrome can be severe producing acute delirium and may require hospitalization in an intensive care unit for management. Management of<unk>  dependence involves considering the person's age, comorbidity and the pharmacological pathways of<unk> . The mainstay of treatment for severe withdrawal is supportive care and benzodiazepines for control of acute delirium, but larger doses are often required compared to acute delirium of other causes (e.g. > 100 mg/d of diazepam). Baclofen has been suggested as an alternative or adjunct to benzodiazepines based on anecdotal evidence and some animal data. However, there is less experience with the use of baclofen for<unk>  withdrawal, and additional research in humans is needed. Baclofen was first suggested as an adjunct because benzodiazepines do not affect GABAB receptors and therefore have no cross-tolerance with<unk>  while baclofen, which works via GABAB receptors, is cross-tolerant with<unk>  and may be more effective in alleviating withdrawal effects of<unk> .<unk>  withdrawal is not widely discussed in textbooks and some psychiatrists, general practitioners, and even hospital emergency physicians may not be familiar with this withdrawal syndrome.
Gamma-Hydroxybutyric acid
Gamma-Amino-beta-hydroxybutyric acid
Choline
Beta-Hydroxy beta-methylbutyric acid
Phenylacetic acid
Butyric acid
Arachidonic acid
Glutamate 