Department of Toxicology, Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Toxicology, Institute of Legal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.
J Forensic Sci. 2022 Jan;67(1):416-427. doi: 10.1111/1556-4029.14880. Epub 2021 Sep 15.
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.
γ-羟基丁酸（GHB）过量会导致呼吸抑制、昏迷，甚至死亡。中毒的症状和严重程度取决于血液浓度和个体因素，如耐受性。本研究对 GHB 中毒病例进行了回顾性病例研究。通过气相色谱-质谱联用（GC-MS）以及部分酶法测定血液和尿液中的 GHB 浓度。评估 GHB 浓度、人口统计学数据和其他药物使用情况以及特定的临床信息。检查血液中 GHB 水平与相关症状之间的相关性。共纳入来自汉堡和周边医院急诊科的 75 例病例。54 例患者（72%）为男性。血液中 GHB 的平均浓度为 248mg/L（范围 21.5-1418mg/L）。在有详细临床信息的组（n=18）中，昏迷组（n=10/18）的平均 GHB 浓度为 244mg/L（范围 136-403mg/L），高于嗜睡和清醒患者。昏迷组中有 70%（n=7）存在一种或多种物质的共同使用，可卡因的额外使用是最常见的（n=5）。结论是，观察到了中等剂量效应关系，尽管在清醒和昏迷患者的 GHB 剂量浓度水平上存在一些重叠。在 GHB 中毒病例中，共同使用很常见，同时还存在酸中毒、低血压和对心率的影响等临床效应。及时分析血液中的 GHB 浓度可以有助于正确诊断昏迷的原因。
