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Accidental calcium, magnesium, potassium and sodium oxybates (Xywave) overdose: mistiming of a single night’s narcolepsy medication leading to respiratory failure requiring mechanical ventilation
  1. Braden W McIntosh and
  2. Charles Mayeux
  1. Emergency Medicine Residency Program, Louisiana State University Health Sciences Center - New Orleans, Baton Rouge, Louisiana, USA
  1. Correspondence to Dr Braden W McIntosh; bmcin1{at}


While typically thought of as an illicit substance, oxybate salts or gamma-hydroxybutyrate (GHB) has more recently been prescribed to treat narcolepsy by enhancing night-time sleep resulting in decreased daytime drowsiness. This case involves a college-aged female with prescribed GHB for narcolepsy who took her second nightly dose too early. This resulted in mental depression, respiratory failure, intubation and mechanical ventilation. The patient was successfully extubated in the intensive care unit several hours later with no residual morbidity. We were unable to identify any prior reports of mixed-salt oxybate toxicity following mistimed drug administration. This case should serve as a warning to emergency physicians to be on the lookout for GHB as part of the differential diagnosis for patients with narcolepsy presenting with altered mental status. It should also serve as a warning to patients and prescribers that this medication can have outcomes that require immediate medical intervention.

  • Contraindications and precautions
  • Sleep disorders (neurology)
  • Safety
  • Unwanted effects / adverse reactions
  • Toxicology

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: BWM and CM. The following authors gave final approval of the manuscript: BWM and CM. Is the patient one of the authors of this manuscript? No.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.