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The use of GHB is still widespread with many hospitalised overdose cases. A man in his fifties was found unconscious in the street and brought to our Acute Admissions. When first examined he was still unconscious, hypothermic, had snoring respiration and smelled of alcohol. He was otherwise haemodynamically stable. Blood samples showed elevated osmolal and anion gaps. The increase in the osmol gap could be explained by the ethanol level of 210mg/dL (46mmol/L), but the reason for the increased anion gap was unknown. Flumazenil and nalox
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