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Characteristics and dose‐effect relationship of clinical gamma‐hydroxybutyrate intoxication: A case series
Author(s) -
Abid Madelaine,
Kietzerow Jana,
IwersenBergmann Stefanie,
Schnitgerhans Tino,
AndresenStreichert Hilke
Publication year - 2022
Publication title -
journal of forensic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.715
H-Index - 96
eISSN - 1556-4029
pISSN - 0022-1198
DOI - 10.1111/1556-4029.14880
Subject(s) - gamma hydroxybutyrate , coma (optics) , medicine , anesthesia , drug overdose , urine , forensic toxicology , poison control , respiratory system , emergency medicine , chemistry , physics , chromatography , optics
Gamma‐Hydroxybutyrate (GHB) overdoses cause respiratory depression, coma, or even death. Symptoms and severity of poisoning depend on blood‐concentrations and individual factors such as tolerance. A retrospective case study was conducted, evaluating GHB intoxication cases. GHB‐concentrations in blood and urine were determined by gas chromatography‐mass spectrometry (GC‐MS) along with, in part, via enzymatic assay. GHB‐concentrations, demographic data, and additional drug use, as well as specific clinical information, were evaluated. The correlation between GHB‐levels in blood and associated symptoms were examined. In total, 75 cases originating from the Emergency Departments (EDs) of Hamburg and surrounding hospitals were included. Fifty‐four of the patients (72%) were male. The mean GHB‐concentration in blood was 248 mg/L (range 21.5–1418 mg/L). Out of the group with detailed clinical information ( n = 18), the comatose group ( n = 10/18) showed a mean of 244 mg/L (range 136–403 mg/L), which was higher than that of the somnolent and awake patients. Of the comatose collective, 70% ( n = 7) showed co‐use of one or more substances, with the additional use of cocaine being the most frequently detected ( n = 5). In conclusion, a moderate dose‐effect relationship was observed, although, there was some overlap in dosage concentration levels of GHB in awake and comatose patients. In GHB‐intoxication cases, co‐use was common as were clinical effects such as acidosis, hypotension, and impact on the heart rate. Timely analytical determination of the GHB‐concentration in blood could support correct diagnosis of the cause of unconsciousness.