Gamma-hydroxybutyric acid (GHB) measurement by GC-MS in blood, urine and gastric contents, following an acute intoxication in Belgium.
Gamma-hydroxybutyrate (GHB, sodium oxybate) is a compound related to neuromodulator gamma-aminobutyric acid (GABA), emerging as a recreational drug of abuse and as a rape drug. GHB-related emergencies have dramatically increased in the 1990s, but a decrease is observed since 2000. We describe the case of an acute GHB intoxication in a 28-year-old male who fell unconscious after ingestion of a mouthful of an unknown beverage, and required medical support for 2 days. A cocaine abuse was also detected by preliminary toxicological screening, but the clinical presentation was not typical of cocaine intoxication. A simple liquid-liquid extraction was used for quantitation of GHB, followed by disilyl-derivatization and analysis in selective ion monitoring (SIM) mode by gas chromatography-mass spectrometry (GC-MS), using GHB-d6 as internal standard. High concentrations of GHB were detected in urine (3020 mg/L) and gastric contents (71487 mg/L) at admission. After a 6-hours delay, GHB was still present in urine at 2324 mg/L and in blood at 43 mg/L. The clinical symptoms of cocaine intoxication were diminished by GHB consumption, and the cerebral scan was modified. Attention must thus be paid to acute intoxications with surprising clinical symptoms, and GHB has probably to be added to the preliminary toxicological screening. Data available regarding GHB are briefly reviewed, and our results are compared with previously published reports of non-fatal GHB intoxication.
Bodson
Q
Q
Laboratoire de Toxicologie, Université de Liège, CHU Sart-Tilman, Belgium. Q.Bodson@ulg.ac.be
Denooz
R
R
Serpe
P
P
Charlier
C
C
D000328:Adult; D001530:Belgium; D003042:Cocaine / Q000493:pharmacokinetics / Q000506:poisoning*; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000175:diagnosis / Q000378:metabolism*; D008401:Gas Chromatography-Mass Spectrometry / Q000379:methods*; D005750:Gastric Juice / Q000737:chemistry*; D006801:Humans; D006885:Hydroxybutyrates / Q000032:analysis / Q000097:blood / Q000652:urine; D008297:Male; D015813:Substance Abuse Detection / Q000379:methods*
D006885:Hydroxybutyrates; C111420:4-hydroxybutyric acid; D003042:Cocaine