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1,4-Butanediol is added to a wide variety of dietary supplements to enhance sleep, libido, athletic performance, fat metabolism, and relaxation. It is also used as an industrial solvent. After ingestion, it is rapidly metabolized to gamma-hydroxybutyrate, which itself is abused for euphoric and sexual side effects. This report describes 9 episodes of severe toxic effects from 1,4-butanediol in 8 patients, 2 of whom died.
Clinical findings included vomiting, urinary and fecal incontinence, agitation, combativeness, labile level of consciousness, coma, and death. 1,4-Butanediol was undetectable in nonfatal cases, but gamma-hydroxybutyrate concentrations in the blood and urine far exceeded normal concentrations. The amount ingested ranged from …