title: Detection of gamma hydroxybutyrate in emergency department: Nice to have or a valuable diagnostic tool?
abstract: BACKGROUND
  Many patients present to emergency departments (EDs) with an altered state of consciousness. Fast exclusion of gamma hydroxybutyrate (GHB)-associated intoxication in these patients may optimize diagnostic and therapeutic algorithms and decisions in the ED.
  
  
  METHODS
  Between January and March 2014, a novel enzymatic test system was used to quantify GHB in blood and urine samples of suspected intoxicated patients in the ED of the University Hospital. The underlying causes for suspected intoxication and the diagnostic and therapeutic measures were documented and analysed retrospectively.
  
  
  RESULTS
  GHB measurements were performed in 13 patients with suspected ingestion during a 3-month study period. GHB was positive in six patients showing serum levels between 61.8 mg/l and 254.8 mg/l, and GHB was tested negative in seven patients with a range of 0.3-6.2 mg/l (upper reference limit 6.1 mg/l). Additional intoxication was found in five of six GHB positive (83%, alcohol n = 2 and other drugs n = 5) and in six of seven negative-tested patients (86%, alcohol n = 5 and other drugs n = 1).
  
  
  CONCLUSIONS
  GHB quantification in the ED provides specific additional information for intoxication, which can lead to more precise diagnostic and therapeutic decisions and may also be important for legal aspects. We believe that GHB analysis in unconscious patients with suspected intoxication may improve the efficient treatment of intoxicated patients.
authors.affiliation: Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Drogies
authors.affiliation: Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Willenberg
authors.affiliation: Emergency Department, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Ramshorn-Zimmer
authors.affiliation: Medical Intensive Care Unit, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Weidhase
authors.affiliation: Medical Intensive Care Unit, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Petros
authors.affiliation: Institute for Legal Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hädrich
authors.affiliation: Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Thiery
authors.affiliation: Emergency Department, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gries
authors.affiliation: Emergency Department, University Hospital of Leipzig, Leipzig, Germany michael.bernhard@medizin.uni-leipzig.de.
authors.forename: M
authors.initials: M
authors.lastname: Bernhard
mesh_terms: D000328:Adult; D003657:Decision Making; D062787:Drug Overdose / Q000097:blood / Q000652:urine; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005858:Germany; D006207:Half-Life; D006801:Humans; D013287:Illicit Drugs / Q000097:blood* / Q000633:toxicity / Q000652:urine*; D057230:Limit of Detection; D008297:Male; D012189:Retrospective Studies; D012978:Sodium Oxybate / Q000097:blood* / Q000633:toxicity / Q000652:urine*; D015813:Substance Abuse Detection / Q000379:methods*
chemical_list: D013287:Illicit Drugs; D012978:Sodium Oxybate
keywords: Gamma hydroxybutyrate; decision-making; emergency department; intoxication; laboratory investigation