Jones A W, Holmgren A, Kugelberg F C, Busardò F P
Department of Clinical Pharmacology, University of Linköping, Linköping, Sweden.
Division of Forensic Toxicology, National Board of Forensic Toxicology, Linköping, Sweden.
J Anal Toxicol. 2018 Nov 1;42(9):587-591. doi: 10.1093/jat/bky041.
This article reports the concentrations of gamma-hydroxybutyrate (GHB) in femoral blood and bladder urine in a case series of drug intoxication deaths (N = 37). GHB was determined in blood (B-GHB) and urine (U-GHB) by a GC-FID-GBL method and 30 mg/L was used as a cut-off concentration for reporting positive results. The mean (median) and range of GHB concentrations in bladder urine were 2,818 mg/L (1,900 mg/L) and 120-13,000 mg/L, respectively. These concentrations were appreciably higher than those in femoral blood, 637 mg/L (260 mg/L) and 30-9,200 mg/L, respectively. Urine/blood ratios of GHB were highly variable (mean 8.99, median 5.33 and range 0.16-29.3). GHB is rapidly metabolized and cleared from the bloodstream, whereas there is no metabolism occurring in the urinary bladder. In five autopsy cases, U-GHB was lower than B-GHB, which suggests that these individuals died before equilibration of the drug in all body fluids and tissues. In the other 32 deaths, U-GHB was higher than B-GHB, sometimes appreciably higher, which points towards a longer survival time after intake or administration of GHB. The analysis of urine extends the window of detection of GHB by several hours compared with blood samples, depending in part on when the bladder was last voided before death. Furthermore, the urinary concentration of GHB gives a hint about the concentration in blood during the time that the urine was produced in the kidney and stored in the bladder since the previous void.
本文报告了一系列药物中毒死亡病例（N = 37）中股静脉血和膀胱尿液中γ-羟基丁酸（GHB）的浓度。采用气相色谱-氢火焰离子化检测器-γ-丁内酯（GC-FID-GBL）法测定血液（B-GHB）和尿液（U-GHB）中的GHB，并将30 mg/L作为报告阳性结果的截断浓度。膀胱尿液中GHB浓度的均值（中位数）和范围分别为2818 mg/L（1900 mg/L）和120 - 13000 mg/L。这些浓度明显高于股静脉血中的浓度，股静脉血中GHB浓度的均值（中位数）和范围分别为637 mg/L（260 mg/L）和30 - 9200 mg/L。GHB的尿/血比值变化很大（均值8.99，中位数5.33，范围0.16 - 29.3）。GHB在血液中迅速代谢并清除，而在膀胱中不发生代谢。在5例尸检病例中，U-GHB低于B-GHB，这表明这些个体在药物在所有体液和组织中达到平衡之前就已死亡。在其他32例死亡病例中，U-GHB高于B-GHB，有时明显更高，这表明摄入或使用GHB后存活时间更长。与血液样本相比，尿液分析将GHB的检测窗口延长了几个小时，这部分取决于死亡前膀胱最后一次排尿的时间。此外，GHB的尿液浓度提示了自上次排尿后肾脏产生并储存在膀胱中的尿液生成期间血液中的浓度。
