{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T21:08:25Z","timestamp":1774732105117,"version":"3.50.1"},"reference-count":18,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,5,18]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2024-260025","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T12:04:30Z","timestamp":1718366670000},"page":"e260025","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Accidental calcium, magnesium, potassium and sodium oxybates (Xywave) overdose: mistiming of a single night\u2019s narcolepsy medication leading to respiratory failure requiring mechanical ventilation"],"prefix":"10.1136","volume":"17","author":[{"given":"Braden W","family":"McIntosh","sequence":"first","affiliation":[{"name":"Emergency Medicine Residency Program, Louisiana State University Health Sciences Center - New Orleans, Baton Rouge, Louisiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Mayeux","sequence":"additional","affiliation":[{"name":"Emergency Medicine Residency Program, Louisiana State University Health Sciences Center - New Orleans, Baton Rouge, Louisiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,5,31]]},"reference":[{"key":"2025082709380821000_17.5.e260025.1","doi-asserted-by":"crossref","first-page":"16100","DOI":"10.1038\/nrdp.2016.100","article-title":"Narcolepsy","volume":"3","author":"Kornum","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"2025082709380821000_17.5.e260025.2","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/S0025-7125(16)33982-7","article-title":"Med","volume":"44","author":"Yoss","year":"1960","journal-title":"Clin North Am"},{"key":"2025082709380821000_17.5.e260025.3","doi-asserted-by":"crossref","DOI":"10.1093\/sleep\/zsw010","article-title":"Temporal changes in the cerebrospinal fluid level of Hypocretin-1 and histamine in Narcolepsy","volume":"40","author":"Lopez","year":"2017","journal-title":"Sleep"},{"key":"2025082709380821000_17.5.e260025.4","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1212\/WNL.0000000000001051","article-title":"Primary progressive Narcolepsy type 1: the other side of the coin","volume":"83","author":"Pizza","year":"2014","journal-title":"Neurology"},{"key":"2025082709380821000_17.5.e260025.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2013.03.002."},{"key":"2025082709380821000_17.5.e260025.6","doi-asserted-by":"crossref","first-page":"S107","DOI":"10.1093\/sleep\/17.suppl_8.S107","article-title":"Modafinil: a double-blind Multicentric study","volume":"17","author":"Billiard","year":"1994","journal-title":"Sleep"},{"key":"2025082709380821000_17.5.e260025.7","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1093\/sleep\/17.suppl_8.S103","article-title":"Narcolepsy and its treatment with stimulants. 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(2020) . Label for XYWAV ((calcium, magnesium, potassium, and sodium Oxybates). 2020. 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