title: Near-fatal persistent anion- and osmolal-gap acidosis due to massive gamma-butyrolactone/ethanol intoxication.
abstract: We report a case of an ethanol and massive gamma-butyrolactone (GBL) intoxication, the precursor of the recreational drug gamma-hydroxybutyric acid (GHB), resulting in life-threatening metabolic acidosis (pH 6.5) with a highly increased anion- and osmolal gap. Rapid analysis using gas chromatography revealed a GHB plasma concentration of 4400 mg/L, far above the upper limit concentration of 1000 mg/L found in adult fatalities attributed to GBL. Full recovery was established following supportive treatment including haemodialysis. This is the first report of a combined ethanol/GBL intoxication as a cause of high serum anion- and osmolal-gap metabolic acidosis.
authors.affiliation: Department of Intensive Care, Sint-Augustinus Hospital, Wilrijk, Belgium luc.heytens@gza.be.
authors.forename: Luc
authors.initials: L
authors.lastname: Heytens
authors.affiliation: Toxicological Center, University of Antwerp, Antwerp, Belgium Laboratory for Clinical Chemistry and Toxicology, ZNA Stuivenberg, Antwerp, Belgium.
authors.forename: Hugo
authors.initials: H
authors.lastname: Neels
authors.affiliation: Department of Intensive Care Medicine, ZNA Stuivenberg, Antwerp, Belgium.
authors.forename: Niels
authors.initials: N
authors.lastname: Van Regenmortel
authors.affiliation: Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
authors.affiliation: Department of Nephrology, Sint-Augustinus Hospital, Wilrijk, Belgium.
authors.forename: Manu
authors.initials: M
authors.lastname: Henckes
authors.affiliation: Clinical Laboratory, Sint-Augustinus Hospital, Wilrijk, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Schouwers
authors.affiliation: Laboratory for Clinical Chemistry and Toxicology, ZNA Stuivenberg, Antwerp, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Dockx
authors.affiliation: Toxicological Center, University of Antwerp, Antwerp, Belgium.
authors.forename: Cleo L
authors.initials: CL
authors.lastname: Crunelle
mesh_terms: D015107:4-Butyrolactone / Q000097:blood / Q000633:toxicity*; D000138:Acidosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D000435:Alcoholic Intoxication / Q000150:complications / Q000503:physiopathology*; D003128:Coma / Q000209:etiology; D003131:Combined Modality Therapy; D003490:Cyanosis / Q000209:etiology; D062787:Drug Overdose / Q000150:complications / Q000503:physiopathology*; D004632:Emergency Medical Services; D006801:Humans; D013287:Illicit Drugs / Q000097:blood / Q000633:toxicity*; D008297:Male; D006435:Renal Dialysis; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D013287:Illicit Drugs; D015107:4-Butyrolactone
keywords: Gamma-butyrolactone; anion gap; high anion-gap metabolic acidosis; intoxication; osmolal gap acidosis