Franken Linda G, Andrews Louise M, Slooff Valerie D, de Wildt Saskia N, Koch Birgit C P
*Department of Hospital Pharmacy, Erasmus MC, Rotterdam; and †Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
Ther Drug Monit. 2016 Feb;38(1):1-3. doi: 10.1097/FTD.0000000000000244.
The authors discuss the case of a 14-year-old girl who was transferred to the ICU of our hospital with ethanol intoxication (3.3 g/L), loss of consciousness (E5M3V1), and severe amnesia on recovery that was suspected of gamma-hydroxybutyric acid (GHB) intoxication. STAT toxicology screening may be necessary, when sexual assault under GHB intoxication is suspected. Therefore, the initial analysis of a urine sample was performed with a new enzymatic assay analysis for GHB. The enzymatic assay reported a GHB concentration of 26 mg/L, which is above the cut-off value of 10 mg/L. This cut-off value is to differentiate endogenous and exogenous levels because low levels of GHB occur naturally in the body. However, confirmation of these results by gas chromatography, which is common practice to confirm a positive GHB, gave a negative result. This discrepancy is probably contributed to interference of ethanol with the assay. This is a substantial downside of the GHB rapid screening, since the combination of GHB and ethanol is common. It is therefore advised to confirm that the positive GHB results are lower than 50 mg/L by gas chromatography, when using the rapid screening. This way the false-positive results and consequent inappropriate social and legal actions may be avoided.
作者讨论了一名14岁女孩的病例，该女孩因乙醇中毒（3.3 g/L）、意识丧失（E5M3V1）以及恢复后严重失忆而被转至我院重症监护病房，怀疑为γ-羟基丁酸（GHB）中毒。当怀疑存在GHB中毒下的性侵犯时，可能需要进行毒物快速检测。因此，对一份尿液样本进行了针对GHB的新型酶法分析。酶法分析报告的GHB浓度为26 mg/L，高于10 mg/L的临界值。该临界值用于区分内源性和外源性水平，因为人体中自然会出现低水平的GHB。然而，通过气相色谱法对这些结果进行确认（这是确认GHB阳性的常用方法）却得出了阴性结果。这种差异可能是由于乙醇对该检测产生了干扰。这是GHB快速检测的一个重大缺点，因为GHB和乙醇同时存在的情况很常见。因此，建议在使用快速检测时，通过气相色谱法确认阳性GHB结果低于50 mg/L。这样可以避免假阳性结果以及随之而来的不适当的社会和法律行动。
