title: A multi-drug intoxication fatality involving Xyrem (GHB).
abstract: Gamma-hydroxybutyrate (GHB) is best known as a recreational depressant drug, whose use has also been implicated in drug facilitated sexual assault cases. It is also available as a therapeutic agent (Xyrem) used for the treatment of daytime sleepiness or cataplexy associated with narcolepsy. This is a report of a case of a 53-year-old woman undergoing treatment with Xyrem for narcolepsy. The decedent was also prescribed tramadol, gabapentin, cetirizine, modafinil, carisoprodol, and Xyrem. Toxicological analysis of the blood revealed GHB 165.6 mg/L, and 90.7 mg/L in the urine. Blood GHB concentrations in the range 156-260 mg/L have been reported to induce moderately sound sleep. The combined use of central nervous system depressant drugs, together with her problematic sleep apnea, and snoring (both contraindications for GHB use) were determined to have caused this subject's death. The manner of death was determined to be accidental.
authors.affiliation: Washington State Patrol, Forensic Laboratory Services Bureau, 2203 Airport Way S., Suite 360, Seattle, WA 98134, USA.
authors.forename: Brianne E
authors.initials: BE
authors.lastname: Akins
authors.forename: Estuardo
authors.initials: E
authors.lastname: Miranda
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Lacy
authors.forename: Barry K
authors.initials: BK
authors.lastname: Logan
mesh_terms: D000588:Amines / Q000032:analysis / Q000506:poisoning; D001559:Benzhydryl Compounds / Q000032:analysis / Q000506:poisoning; D002328:Carisoprodol / Q000032:analysis / Q000506:poisoning; D002492:Central Nervous System Depressants / Q000032:analysis / Q000506:poisoning*; D017332:Cetirizine / Q000032:analysis / Q000506:poisoning; D003509:Cyclohexanecarboxylic Acids / Q000032:analysis / Q000506:poisoning; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D053593:Forensic Toxicology; D000077206:Gabapentin; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D008875:Middle Aged; D000077408:Modafinil; D009290:Narcolepsy / Q000188:drug therapy*; D012891:Sleep Apnea Syndromes / Q000150:complications; D012913:Snoring / Q000150:complications; D012978:Sodium Oxybate / Q000032:analysis / Q000506:poisoning*; D014147:Tramadol / Q000009:adverse effects / Q000032:analysis; D014822:Vitreous Body / Q000737:chemistry; D005680:gamma-Aminobutyric Acid / Q000032:analysis / Q000506:poisoning
chemical_list: D000588:Amines; D001559:Benzhydryl Compounds; D002492:Central Nervous System Depressants; D003509:Cyclohexanecarboxylic Acids; D002328:Carisoprodol; D014147:Tramadol; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D012978:Sodium Oxybate; D000077408:Modafinil; D017332:Cetirizine