1
|
Dufayet L, Bargel S, Bonnet A, Boukerma AK, Chevallier C, Evrard M, Guillotin S, Loeuillet E, Paradis C, Pouget AM, Reynoard J, Vaucel JA. Gamma-hydroxybutyrate (GHB), 1,4-butanediol (1,4BD), and gamma-butyrolactone (GBL) intoxication: A state-of-the-art review. Regul Toxicol Pharmacol 2023; 142:105435. [PMID: 37343712 DOI: 10.1016/j.yrtph.2023.105435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
γ-hydroxybutyrate (GHB) is synthesized endogenously from γ-aminobutyric acid (GABA) or exogenously from 1,4-butanediol (butane-1,4-diol; 1,4-BD) or γ-butyrolactone (GBL). GBL, and 1,4-BD are rapidly converted to GHB. The gastric absorption time, volume of distribution, and half-life of GHB are between 5 and 45 min, 0.49 ± 0.9 L/kg, and between 20 and 60 min, respectively. GHB and its analogues have a dose-dependent effect on the activation of GHB receptor, GABA-B, and GABA localized to the central nervous system. After ingestion, most patients present transient neurological disorders (lethal dose: 60 mg/kg). Chronic GHB consumption is associated with disorders of use and a withdrawal syndrome when the consumption is discontinued. GHB, GBL, and 1,4-BD are classified as narcotics but only the use of GHB is controlled internationally. They are used for drug facilitated (sexual) assault, recreational purposes, slamsex, and chemsex. To confirm an exogenous intake or administration of GHB, GBL, or 1-4-BD, the pre-analytical conservation is crucial. The antemortem cutoff doses for detection are 5 and 5-15 mg/L, with detection windows of 6 and 10 h in the blood and urine, respectively Control of GHB is essential to limit the number of users, abuse, associated risks, and death related to their consumption.
Collapse
Affiliation(s)
- Laurene Dufayet
- Unité Médico-judiciaire, Hôtel-Dieu, APHP, 75001, Paris, France; Centre Antipoison de Paris - Fédération de Toxicologie (FeTox), Hôpital Fernand-Widal, APHP, 75010, Paris, France; INSERM, UMRS-1144, Faculté de Pharmacie, 75006, Paris, France; UFR de Médecine, Université de Paris, 75010, Paris, France.
| | - Sophie Bargel
- Section Toxicologie - Sécurité Routière, Laboratoire de Police Scientifique de Lille, SNPS, France
| | - Anastasia Bonnet
- Centre Antipoison de Toulouse, CHU de Toulouse, Toulouse, France
| | | | | | - Marion Evrard
- Centre Antipoison de Nancy, CHRU de Nancy, Nancy, France
| | - Sophie Guillotin
- Centre Antipoison de Toulouse, CHU de Toulouse, Toulouse, France
| | | | - Camille Paradis
- Centre Antipoison de Bordeaux CHU de Bordeaux, Bordeaux, France
| | | | - Julien Reynoard
- Pharmacologie Clinique CAP-TV, APHM, Hôpitaux Sud, Marseille, France
| | | |
Collapse
|
2
|
Loos N, van den Hondel K, Reijnders U, Franssen E. Complications in post-mortem GHB cut-off values in urine samples: A case report. Toxicol Rep 2023; 10:600-603. [PMID: 37213812 PMCID: PMC10196806 DOI: 10.1016/j.toxrep.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
Gamma-hydroxybutyric acid (GHB) is a drug of abuse, that interplays with a GABAergic system, resulting in an euphoric state and increased mood and impulses. Two cases of fatal mixed intoxications including GHB intake are presented here. In both cases, GHB was used together with multiple other drugs. Interpretation of GHB cut-off values are complicated in post-mortem analysis, because GHB can be post-mortem formed. The post-mortem GHB formation is dependent of the post-mortem interval (PMI) and the storage conditions of the samples. The GHB concentrations in urine are more stable compared to blood samples, when the samples are stored at the correct way at - 20 °C. Therefore, urine is the recommended matrix to analyze in toxicological screenings, since it allows more specific determination of exposure to exogenous GHB. Different cut-off values are used for matrices from living and deceased people. A cut-off value of 30 mg/L is recommended to discriminate between endogenous concentrations and concentrations resulting from exogenous GHB exposure. Moreover, post-mortem GHB formation can take place before sampling. However, when the samples are immediately stored at cooled conditions, no in vitro formation of GHB will take place. Urinary screening of GHB may serve as an initial screening for estimation of exposure of GHB in the body. However, additional quantitative GHB analysis in blood is required to estimate GHB exposure at the time of death. Furthermore, to obtain more reliable results for the ante-mortem GHB exposure, it may be useful to measure other biomarkers, like some GHB metabolites, especially in blood.
Collapse
Affiliation(s)
- N.H.C. Loos
- The Netherlands Cancer Institute, Division of Pharmacology, Amsterdam, the Netherlands
- OLVG Hospital Amsterdam, Department of Hospital Pharmacy, Amsterdam, the Netherlands
- Correspondence to: Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - K.E. van den Hondel
- Public Health Service, Department of Forensic Medicine, Amsterdam, the Netherlands
| | - U.J.L. Reijnders
- Public Health Service, Department of Forensic Medicine, Amsterdam, the Netherlands
| | - E.J.F. Franssen
- OLVG Hospital Amsterdam, Department of Hospital Pharmacy, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Acide γ-Hydroxybutyrique (GHB), γ-butyrolactone (GBL) et 1,4-butanediol (1,4-BD) : revue de la littérature des aspects pharmacologiques, cliniques, analytiques et médico-légaux. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
4
|
Kim S, Choi S, Lee MS, Kim M, Park M, Han S, Han S, Lee HS, Lee S. Urinary Profile of Endogenous Gamma-Hydroxybutyric Acid and its Biomarker Metabolites in Healthy Korean Females: Determination of Age-Dependent and Intra-Individual Variability and Identification of Metabolites Correlated With Gamma-Hydroxybutyric Acid. Front Pharmacol 2022; 13:853971. [PMID: 35496306 PMCID: PMC9043528 DOI: 10.3389/fphar.2022.853971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
Gamma-hydroxybutyric acid (GHB), used as a therapeutic and an illegal anesthetic, is a human neurotransmitter produced during gamma-aminobutyric acid (GABA) biosynthesis and metabolism. Potential biomarker metabolites of GHB intoxication have been identified previously; however, reference concentrations have not been set due to the lack of clinical study data. Urinary profiling of endogenous GHB and its biomarker metabolites in urine samples (n = 472) of 206 healthy females was performed based on differences in age and time of sample collection using liquid chromatography-tandem mass spectrometry following validation studies. The unadjusted and creatinine-adjusted urinary concentrations ranges were obtained after urinary profiling. The creatinine-adjusted concentrations of glutamic and succinic acids and succinylcarnitine significantly increased, whereas that of glycolic acid significantly decreased with advancing age. Significant inter-day variation of GABA concentration and intra-day variation of 3,4-dihydroxybutyric acid and succinylcarnitine concentrations were observed. The urinary concentrations of 2,4-dihydroxybutyric acid, succinic acid, and 3,4-dihydroxybutyric acid showed the highest correlation with that of GHB. Data from this study suggest population reference limits to facilitate clinical and forensic decisions related to GHB intoxication and could be useful for identification of biomarkers following comparison with urinary profiles of GHB-administered populations.
Collapse
Affiliation(s)
- Suji Kim
- Analytical Toxicology Laboratory, College of Pharmacy, Keimyung University, Daegu, South Korea
| | - Suein Choi
- Pharmacometrics Institute for Practical Education and Training, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Min Seo Lee
- Drug Metabolism and Bioanalysis Laboratory and BK21 Four-Sponsored Advanced Program for SmartPharma Leaders, College of Pharmacy, The Catholic University of Korea, Bucheon, South Korea
| | - Mingyu Kim
- Analytical Toxicology Laboratory, College of Pharmacy, Keimyung University, Daegu, South Korea
| | - Maria Park
- Pharmacometrics Institute for Practical Education and Training, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sungpil Han
- Pharmacometrics Institute for Practical Education and Training, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seunghoon Han
- Pharmacometrics Institute for Practical Education and Training, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hye Suk Lee
- Drug Metabolism and Bioanalysis Laboratory and BK21 Four-Sponsored Advanced Program for SmartPharma Leaders, College of Pharmacy, The Catholic University of Korea, Bucheon, South Korea
- *Correspondence: Hye Suk Lee, ; Sooyeun Lee,
| | - Sooyeun Lee
- Analytical Toxicology Laboratory, College of Pharmacy, Keimyung University, Daegu, South Korea
- *Correspondence: Hye Suk Lee, ; Sooyeun Lee,
| |
Collapse
|
5
|
Effect of Body Refrigeration on the Postmortem Formation of Gamma Hydroxybutyrate in Whole Blood. Forensic Sci Int 2022; 334:111247. [DOI: 10.1016/j.forsciint.2022.111247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 11/19/2022]
|
6
|
Derivatization-assisted LC-MS/MS method for simultaneous quantification of endogenous gamma-hydroxybutyric acid and its metabolic precursors and products in human urine. Anal Chim Acta 2022; 1194:339401. [DOI: 10.1016/j.aca.2021.339401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/01/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022]
|
7
|
Kraemer M, Broecker S, Kueting T, Madea B, Maas A. Fatty acid esters as novel metabolites of γ-hydroxybutyric acid: A preliminary investigation. Drug Test Anal 2022; 14:690-700. [PMID: 34983082 DOI: 10.1002/dta.3213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022]
Abstract
γ-Hydroxybutyric acid (GHB) is a substance frequently abused as a knockout agent. Because of possible amnesia experienced by victims of GHB exposure and the short detection time of GHB in biological samples, the proof of GHB uptake is often challenging for forensic toxicologists. For this reason, various approaches have been evaluated to prolong the detection of GHB intake. In the present study, a fatty acid ester of GHB (4-palmitoyloxy butyrate [GHB-Pal; 3-carboxypropyl hexadecanoate]) was synthesized with the intent of examining whether such esters could be detected as metabolites of GHB in blood samples. Using the structurally elucidated synthesis product (structural elucidation by means of high performance liquid chromatography quadrupole time of flight mass spectrometry [LC-QToF-MS]), an LC triple quadrupole mass spectrometric (LC-MS/MS) method was established for the detection of GHB-Pal. Blood (plasma) samples from four cases in which GHB was previously detected at relevant concentrations (56.1-96.5 μg/ml) were analyzed with respect to GHB-Pal. Signals for GHB-Pal, as well as possible signals for other fatty acid esters of GHB, were detectable in these specimens. (Negative) control samples (20 plasma samples and 20 red blood cell/blood clot samples; from cases in which an intake of GHB or its precursors was not assumed) were all negative for GHB-Pal. To evaluate a possible forensic benefit of GHB fatty acid esters (prolongation of the detection window of a GHB uptake), the analysis of additional plasma samples collected after GHB uptake (or controlled GHB administration) and quantification of GHB fatty acid esters are needed.
Collapse
Affiliation(s)
- Michael Kraemer
- Institute of Forensic Medicine, University Hospital Bonn, Forensic Toxicology, Bonn, Germany
| | | | - Theresa Kueting
- Institute of Forensic Medicine, University Hospital Bonn, Forensic Toxicology, Bonn, Germany.,Institute of Forensic Medicine, University Hospital Essen, Forensic Toxicology, Essen, Germany
| | - Burkhard Madea
- Institute of Forensic Medicine, University Hospital Bonn, Forensic Toxicology, Bonn, Germany
| | - Alexandra Maas
- Institute of Forensic Medicine, University Hospital Bonn, Forensic Toxicology, Bonn, Germany
| |
Collapse
|
8
|
Abid M, Kietzerow J, Iwersen-Bergmann S, Schnitgerhans T, Andresen-Streichert H. Characteristics and dose-effect relationship of clinical gamma-hydroxybutyrate intoxication: A case series. J Forensic Sci 2021; 67:416-427. [PMID: 34523720 DOI: 10.1111/1556-4029.14880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/20/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- Madelaine Abid
- Department of Toxicology, Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Kietzerow
- Department of Toxicology, Institute of Legal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Stefanie Iwersen-Bergmann
- Department of Toxicology, Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tino Schnitgerhans
- Department of Internal Medicine, Asklepios-Klinik Nord - Heidberg, Hamburg, Germany
| | - Hilke Andresen-Streichert
- 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
| |
Collapse
|
9
|
Arfè R, Bilel S, Tirri M, Frisoni P, Serpelloni G, Neri M, Boccuto F, Bernardi T, Foti F, De-Giorgio F, Marti M. Comparison of N-methyl-2-pyrrolidone (NMP) and the "date rape" drug GHB: behavioral toxicology in the mouse model. Psychopharmacology (Berl) 2021; 238:2275-2295. [PMID: 33881584 DOI: 10.1007/s00213-021-05852-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/12/2021] [Indexed: 01/07/2023]
Abstract
N-methyl-2-pyrrolidone (NMP) and γ-hydroxybutyrate acid (GHB) are synthetic solvents detected in the recreational drug market. GHB has sedative/hypnotic properties and is used for criminal purposes to compromise reaction ability and commit drug-facilitated sexual assaults and other crimes. NMP is a strong solubilizing solvent that has been used alone or mixed with GHB in case of abuse and robberies. The aim of this experimental study is to compare the acute pharmaco-toxicological effects of NMP and GHB on neurological signs (myoclonia, convulsions), sensorimotor (visual, acoustic, and overall tactile) responses, righting reflex, thermoregulation, and motor activity (bar, drag, and accelerod test) in CD-1 male mice. Moreover, since cardiorespiratory depression is one of the main adverse effects related to GHB intake, we investigated the effect of NMP and GHB on cardiorespiratory changes (heart rate, breath rate, oxygen saturation, and pulse distension) in mice. The present study demonstrates that NMP inhibited sensorimotor and motor responses and induced cardiorespiratory depression, with a lower potency and efficacy compared to GHB. These results suggest that NMP can hardly be used alone as a substance to perpetrate sexual assault or robberies.
Collapse
Affiliation(s)
- Raffaella Arfè
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy.,Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Sabrine Bilel
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Micaela Tirri
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Paolo Frisoni
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Giovanni Serpelloni
- Department of Psychiatry in the College of Medicine, Drug Policy Institute, University of Florida, Gainesville, FL, USA
| | - Margherita Neri
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Federica Boccuto
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Tatiana Bernardi
- Department of Chemistry and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Federica Foti
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Roma, Italia.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Roma, Italia
| | - Fabio De-Giorgio
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Roma, Italia. .,Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Roma, Italia.
| | - Matteo Marti
- Department of Translational Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Collaborative Center for the Italian National Early Warning System, Department of Anti-Drug Policies, Presidency of the Council of Ministers, Rome, Italy.
| |
Collapse
|
10
|
Bertol E, Mari F, Lachi A, Tespio G, Vaiano F. Determination of endogenous GHB levels in chest and pubic hair. Forensic Sci Int 2021; 325:110857. [PMID: 34098474 DOI: 10.1016/j.forsciint.2021.110857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
Endogenous nature of GHB represents a critical issue for forensic toxicologists, especially in alleged sexual assaults. Therefore, discrimination between physiologically and additional amounts from exogenous sources of such a substance must be effective and reliable in order to avoid severe misinterpretation. This study aimed to quantify the GHB baseline concentrations in chest and pubic hairs collected from 105 healthy volunteers, non-consumers of any drugs of abuse. The final scope was to investigate if these keratin matrices could represent valid alternative to scalp hair when not available. Moreover, we also evaluated the age and gender influences on the GHB baseline levels. 25 mg of hair were incubated overnight with NaOH at 56 °C. After acidification with H2SO4, the solution was liquid-liquid extracted with ethyl acetate and a trimethylsilyl derivatization was then achieved. Analysis was performed in gas chromatography-mass spectrometry in single ion monitoring mode (m/z 233, 234, 147 for GHB; m/z 239, 240 and 147 for GHB-d6). The endogenous amount in "blank" hair was estimated by the standard addition method (0.301 for chest hair and 0.235 ng/mg for pubic hair). GHB concentration ranged from 0.205 to 1.511 ng/mg for chest hair and from 0.310 to 1.913 ng/mg for pubic hair. These values were consistent with previous studies on scalp hair and on pubic hair. Unfortunately, research on chest hair is not available in literature. T-Test and Linear Regression highlighted no statistically significant differences for the two matrices and for all age/gender sub-groups. However, further studies are required to estimate a reliable cut-off value for these keratin matrices. For the first time, we demonstrated the suitability of chest and pubic hair to detect endogenous levels of GHB.
Collapse
Affiliation(s)
- Elisabetta Bertol
- Forensic Toxicology Division, Department of Health Science, University of Florence, Largo Brambilla 3, Florence, Italy; U.R.I.To.N - Unit of Research of University of Florence, Florence, Italy
| | - Francesco Mari
- Forensic Toxicology Division, Department of Health Science, University of Florence, Largo Brambilla 3, Florence, Italy; U.R.I.To.N - Unit of Research of University of Florence, Florence, Italy
| | - Alessio Lachi
- Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Giusy Tespio
- Forensic Toxicology Division, Department of Health Science, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Fabio Vaiano
- Forensic Toxicology Division, Department of Health Science, University of Florence, Largo Brambilla 3, Florence, Italy; U.R.I.To.N - Unit of Research of University of Florence, Florence, Italy.
| |
Collapse
|
11
|
Jarsiah P, Roehrich J, Kueting T, Martz W, Hess C. GHB related acids are useful in routine casework of suspected GHB intoxication cases. Forensic Sci Int 2021; 324:110833. [PMID: 34020075 DOI: 10.1016/j.forsciint.2021.110833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
GHB related acids (3,4-dihydroxy butyric acid, 2,4-dihydroxy butyric acid and glycolic acid) are produced through oxidative GHB metabolism. These analytes could be potential biomarkers to ensure the diagnosis of a GHB intoxication and even prolong the detection window. Within this study, forensic routine cases were measured to consider the potential of additional gas chromatographic mass spectrometric analysis on these acids. 17 GHB positive real cases (10 serum samples and 7 urine samples) and 40 cases with suspicion of drugging in DFC cases and negative GHB results (21 serum samples and 19 urine samples) were evaluated. Increased GHB related acid concentrations were detected in all serum and most urine samples positive on GHB. In some GHB negative cases, especially in serum samples, concentrations of GHB related acids gave hints that GHB actually was taken. We recommend to use the following cut-offs for a more reliable interpretation of potential GHB intoxication cases: 3,4-OH-BA:>3 mg/L in serum and>50 mg/L in urine; 2,4-OH-BA:>2 mg/L in serum and>25 mg/L in urine; GA:>5 mg/L in serum and>400 mg/L in urine.
Collapse
Affiliation(s)
- Pouria Jarsiah
- Institute of Forensic Medicine, Forensic Toxicology, Johannes Gutenberg University Mainz, Mainz, Germany; Special Laboratory, Medical Care Centers Dr. Eberhard & Partner, Dortmund, Germany
| | - Joerg Roehrich
- Institute of Forensic Medicine, Forensic Toxicology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Theresa Kueting
- Institute of Forensic Medicine, Forensic Toxicology, University of Bonn, Germany
| | - Walter Martz
- Institute of Forensic Medicine, Forensic Toxicology, University of Gießen, Gießen, Germany
| | - Cornelius Hess
- Institute of Forensic Medicine, Forensic Toxicology, Johannes Gutenberg University Mainz, Mainz, Germany.
| |
Collapse
|
12
|
Küting T, Schneider B, Heidbreder A, Krämer M, Jarsiah P, Madea B, Hess C. Detection of γ-hydroxybutyric acid-related acids in blood plasma and urine: Extending the detection window of an exogenous γ-hydroxybutyric acid intake? Drug Test Anal 2021; 13:1635-1649. [PMID: 33991073 DOI: 10.1002/dta.3097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/24/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022]
Abstract
In crimes facilitated by γ-hydroxybutyric acid (GHB) administration, the frequent occurrence of anterograde amnesia of the victims as well as the short detection window and variations of endogenous GHB concentrations complicate obtaining analytical proof of GHB administration. Because elevated endogenous organic acid concentrations have been found in the urine of patients with succinic semialdehyde deficiency (leading to accumulation of GHB in human specimens) and after GHB ingestion, we searched for an alternative way to prove GHB administration via detection of elevated organic acid concentrations in blood plasma and urine. We collected blood and urine samples from narcolepsy patients (n = 5) treated with pharmaceuticals containing GHB sodium salt (1.86-3.72 g GHB as free acid per dose). Although GHB was detectable only up to 4 h in concentrations greater than the commonly used cutoff levels in blood plasma, 3,4-dihydroxybutyric acid (3,4-DHB) could be detected up to 12 h in blood plasma in concentrations exceeding initial concentrations of the same patient before GHB ingestion. Furthermore, four of the five patients showed an increase above endogenous levels described in the scientific literature. In urine, GHB concentrations above commonly used cutoff levels could be observed 4.5-9.5 h after GHB intake. Creatinine standardized initial concentrations were reached again for glycolic acid (GA), 3,4-DHB, and 2,4-dihydroxybutyric (2,4-DHB) acid at 6.5-22, 11.5-22, and 8.5-70 h after GHB intake, respectively. Therefore, 2,4-DHB, 3,4-DHB, and GA are promising and should be further investigated as potential biomarkers to prolong the detection window of GHB intake.
Collapse
Affiliation(s)
- Theresa Küting
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Bianca Schneider
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Anna Heidbreder
- Medical University Innsbruck, University Hospital for Neurology, Innsbruck, Austria
| | - Michael Krämer
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Pouria Jarsiah
- Institute of Forensic Medicine, University of Mainz, Mainz, Germany.,Special Laboratory, Medical Care Centers, Dr. Eberhard & Partner, Dortmund, Germany
| | - Burkhard Madea
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Cornelius Hess
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany.,Institute of Forensic Medicine, University of Mainz, Mainz, Germany
| |
Collapse
|
13
|
Characteristics of patients with analytically confirmed γ-hydroxybutyric acid/γ-butyrolactone (GHB/GBL)-related emergency department visits in Taiwan. J Formos Med Assoc 2021; 120:1914-1920. [PMID: 33893011 DOI: 10.1016/j.jfma.2021.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 11/21/2022] Open
Abstract
The recreational drug γ-hydroxybutyric acid (GHB) is a central nervous system depressant, and can produce euphoria at low doses. GHB is a controlled substance in Taiwan. However, the organic solvents γ-butyrolactone (GBL) and 1,4-butanediol (BD), which are unregulated, may be used as an alternative source of GHB. There is no clinical report of analytically confirmed GHB use in Taiwan. We retrospective reviewed the clinical characteristics from the medical charts between May 2017 and April 2020. The urine samples of patients presented to the emergency departments with drug-related complaints were sent for toxicological analysis. Patients with urine samples detected GHB >10 μg/mL by liquid chromatography/tandem mass spectrometry were included. Overall, 11 men and one woman with an average age of 35.3 ± 8.7 years were included. Most patients co-ingested amphetamine (n = 6) and initially presented with depressed consciousness levels (n = 7). One patient presented with out-of-hospital cardiac arrest and one with respiratory depression. All patients regained consciousness within 6 h of admission. All patients used GBL to evade conviction. Although patients recovered with supportive care, respiratory failure and cardiac arrest occurred after GHB/GBL use. It is important to legislate GBL and BD as controlled chemical substances in Taiwan.
Collapse
|
14
|
Metabolic Alterations Associated with γ-Hydroxybutyric Acid and the Potential of Metabolites as Biomarkers of Its Exposure. Metabolites 2021; 11:metabo11020101. [PMID: 33578991 PMCID: PMC7916753 DOI: 10.3390/metabo11020101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
γ-Hydroxybutyric acid (GHB) is an endogenous short chain fatty acid that acts as a neurotransmitter and neuromodulator in the mammalian brain. It has often been illegally abused or misused due to its strong anesthetic effect, particularly in drug-facilitated crimes worldwide. However, proving its ingestion is not straightforward because of the difficulty in distinguishing between endogenous and exogenous GHB, as well as its rapid metabolism. Metabolomics and metabolism studies have recently been used to identify potential biomarkers of GHB exposure. This mini-review provides an overview of GHB-associated metabolic alterations and explores the potential of metabolites for application as biomarkers of GHB exposure. For this, we discuss the biosynthesis and metabolism of GHB, analytical issues of GHB in biological samples, alterations in metabolic pathways, and changes in the levels of GHB conjugates in biological samples from animal and human studies. Metabolic alterations in organic acids, amino acids, and polyamines in urine enable discrimination between GHB-ingested animals or humans and controls. The potential of GHB conjugates has been investigated in a variety of clinical settings. Despite the recent growth in the application of metabolomics and metabolism studies associated with GHB exposure, it remains challenging to distinguish between endogenous and exogenous GHB. This review highlights the significance of further metabolomics and metabolism studies for the discovery of practical peripheral biomarkers of GHB exposure.
Collapse
|
15
|
Jarsiah P, Roehrich J, Wyczynski M, Hess C. Phase I metabolites (organic acids) of gamma‐hydroxybutyric acid–validated quantification using GC–MS and description of endogenous concentration ranges. Drug Test Anal 2020; 12:1135-1143. [DOI: 10.1002/dta.2820] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Pouria Jarsiah
- Institute of Forensic Medicine, Forensic Toxicology Johannes Gutenberg University Mainz Mainz Germany
- Special Laboratory, Medical Care Centers Dr. Eberhard & Partner Dortmund Germany
| | - Joerg Roehrich
- Institute of Forensic Medicine, Forensic Toxicology Johannes Gutenberg University Mainz Mainz Germany
| | - Marek Wyczynski
- Special Laboratory, Medical Care Centers Dr. Eberhard & Partner Dortmund Germany
| | - Cornelius Hess
- Institute of Forensic Medicine, Forensic Toxicology Johannes Gutenberg University Mainz Mainz Germany
| |
Collapse
|
16
|
New strategy for carbon monoxide poisoning diagnosis: Carboxyhemoglobin (COHb) vs Total Blood Carbon Monoxide (TBCO). Forensic Sci Int 2019; 306:110063. [PMID: 31790891 DOI: 10.1016/j.forsciint.2019.110063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022]
Abstract
Diagnosis of carbon monoxide (CO) poisonings has always been a challenging task due to the susceptibility to alterations of the optical state and degradation of blood samples during sampling, transport and storage, which highly affects the analysis with spectrophotometric methods. Methodological improvements are then required urgently because of increased reports of cases with discrepancies between results of the measured biomarker carboxyhemoglobin (COHb) and reported symptoms. Total blood CO (TBCO) measured chromatographically was thus proposed in a previous study as alternative biomarker to COHb. This approach was investigated in this study by comparing the two biomarkers and assessing the effects of various storage parameters (temperature, preservative, time, tube headspace (HS) volume, initial saturation level, freeze- and thaw- and reopening-cycles) over a period of one month. Results show that while for TBCO, concentrations are relatively stable over the observation period regardless of parameters such as temperature, time and HS volume, for COHb, concentrations are altered significantly during storage. Therefore, the use of TBCO as alternative biomarker for CO poisonings has been proposed, since it provides more valid results and is more stable even under non-optimal storage conditions. Additionally, it can be used to predict COHb in cases where sample degradation hinders optical measurement. Furthermore, a correction formula for COHb and TBCO is provided to be used in laboratories or circumstances where optimal storage or analysis is not possible, to obtain more accurate results.
Collapse
|
17
|
Kietzerow J, Otto B, Wilke N, Rohde H, Iwersen-Bergmann S, Andresen-Streichert H. The challenge of post-mortem GHB analysis: storage conditions and specimen types are both important. Int J Legal Med 2019; 134:205-215. [PMID: 31598775 DOI: 10.1007/s00414-019-02150-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND For the interpretation of concentrations of gamma-hydroxybutyrate (GHB) in post-mortem specimens, a possible increase due to post-mortem generation in the body and in vitro has to be considered. The influence of different storage conditions and the specimen type was investigated. METHOD AND MATERIAL Post-mortem GHB concentrations in femoral venous blood (VB), heart blood (HB), serum (S) from VB, urine (U), cerebrospinal fluid (CSF) and vitreous humour (VH) were determined by gas chromatography-mass spectrometry after derivatisation. Various storage conditions, that is 4 °C or room temperature (RT) and the addition of sodium fluoride (NaF), were compared during storage up to 30 days. Additionally, bacterial colonisation was determined by mass spectrometry fingerprinting. RESULTS Twenty-six cases without involvement of exogenous GHB were examined. GHB concentrations (by specimen) at day 0 were 3.9-22.1 mg/L (VB), 6.6-33.3 mg/L (HB), < 0.5-18.1 mg/L (U), 1.1-10.4 mg/L (CSF) and 1.7-22.0 mg/L (VH). At 4 °C, concentrations increased at day 30 to 5.6-74.5 mg/L (VB), 4.6-76.5 mg/L (HB) and < 0.5-21.3 mg/L (U). At RT, concentrations rose to < 0.5-38.5 mg/L (VB), 1.2-94.6 mg/L (HB) and < 0.5-37.5 mg/L (U) at day 30. In CSF, at RT, an increase up to < 0.5-21.2 mg/L was measured, and at 4 °C, a decrease occurred (< 0.5-6.5 mg/L). GHB concentrations in VH remained stable at both temperatures (1.2-20.9 mg/L and < 0.5-26.2 mg/L). The increase of GHB in HB samples with NaF was significantly lower than that without preservation. No correlation was found between the bacterial colonisation and extent of GHB concentration changes. CONCLUSION GHB concentrations can significantly increase in post-mortem HB, VB and U samples, depending on storage time, temperature and inter-individual differences. Results in CSF, VH, S and/or specimens with NaF are less affected.
Collapse
Affiliation(s)
- J Kietzerow
- Institute of Legal Medicine, Department of Forensic Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Legal Medicine, Department of Forensic Toxicology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - B Otto
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Wilke
- Institute of Forensic Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - H Rohde
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Iwersen-Bergmann
- Institute of Legal Medicine, Department of Forensic Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Andresen-Streichert
- Institute of Legal Medicine, Department of Forensic Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Institute of Legal Medicine, Department of Forensic Toxicology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.
| |
Collapse
|
18
|
Lee DH, Kim H, Yun HY, Park M, Choe S, In S, Kim E, Han E, Shin KH. Complementary approach for accurate determination of carbon isotopic compositions in γ-hydroxybutyric acid using gas chromatography/combustion-isotope ratio mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2019; 33:1434-1439. [PMID: 31070267 DOI: 10.1002/rcm.8481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
RATIONALE γ-Hydroxybutyric acid (GHB) is a naturally endogenous neurotransmitter that is popular as a recreational drug due to its sedative, hypnotic, and euphoric effects. GHB derived from endogenous production or exogenous ingestion has been effectively discriminated by carbon isotopic compositions (δ13 C values) through gas chromatography/combustion-isotope ratio mass spectrometry (GC/C-IRMS). However, an unintended uncertainty of isotopic signatures caused by a wide range of GHB quantities remains unsolved when using only single-isotope corrections of the di-TMS derivative. METHODS The δ13 C values of the original GHB standard were first determined by elemental analyzer/isotope ratio mass spectrometry (EA/IRMS). The δ13 C values of silylated GHB in concentrations from 10 to 500 ppm were determined by GC/C-IRMS. With respect to the silylated reaction products, the correction of δ13 C values for the introduced carbons was calculated from a stoichiometric mass balance equation. RESULTS The results showed a significant quantity-dependent trend in δ13 C values of introduced carbon (δ13 Cdi-TMS values) with increased GHB standard concentrations (r2 = 0.70, p <0.05). We applied a logarithmic equation to determine isotopic data in low-GHB urine specimens from five healthy female volunteers. The δ13 CGHB values in urine samples corrected with quantity-dependent δ13 Cdi-TMS values were different by an average of 2.7‰ from those corrected with single δ13 Cdi-TMS values (p <0.05). CONCLUSIONS Our results suggest that the overall residual amount-dependent isotope fractionation should be mathematically corrected by the logarithmic function and this may improve the reliability of isotopic analysis to evaluate the origin of GHB before applying the approach to routine toxicological and forensic studies.
Collapse
Affiliation(s)
- Dong-Hun Lee
- Hanyang University, 55 Hanyangdaehak-ro, Sangrok-gu, Ansan, 15588, Republic of Korea
| | - Hyojeong Kim
- College of Pharmacy, Duksung Women's University, 144 Samyang-ro, Dobong-gu, Seoul, 01369, Republic of Korea
- Innovative Drug Center, Duksung Women's University, Seoul, South Korea
| | - Hee Young Yun
- Hanyang University, 55 Hanyangdaehak-ro, Sangrok-gu, Ansan, 15588, Republic of Korea
| | | | | | - Sanghwan In
- National Forensic Service, Republic of Korea
| | - Eunmi Kim
- National Forensic Service, Republic of Korea
| | - Eunyoung Han
- College of Pharmacy, Duksung Women's University, 144 Samyang-ro, Dobong-gu, Seoul, 01369, Republic of Korea
- Innovative Drug Center, Duksung Women's University, Seoul, South Korea
| | - Kyung-Hoon Shin
- Hanyang University, 55 Hanyangdaehak-ro, Sangrok-gu, Ansan, 15588, Republic of Korea
| |
Collapse
|
19
|
Kim H, Lee DH, Go A, Park M, Choe S, In S, Kim E, Lee H, Shin KH, Han E. Differentiation of endogenous and exogenous γ-Hydroxybutyrate in rat and human urine by GC/C/IRMS. Int J Legal Med 2019; 133:1785-1794. [PMID: 30937594 DOI: 10.1007/s00414-019-02052-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
Gamma (γ)-hydroxybutyric acid (GHB) has been reported to be an endogenous compound in the mammalian brain. It used to treat symptoms of alcohol, opioid, and drug withdrawal and cataplexy of narcolepsy. However, it is often used for criminal purposes because it is colorless, tasteless, and has short half-life. For this reason, there is a need for a method of distinguishing between endogenous and exogenous GHB administration. Therefore, urine from rat before administration of GHB and GHB urine after the single intraperitoneal injection of GHB as 30 mg/100 g were collected from Sprague-Dawley rats (7 weeks old, 10 males and females). Negative control urine, urine from individuals suspected of taking GHB, and urine from victims who were GHB-involved crime were collected. In urine samples, GHB was extracted with two-step SPE and collected fraction was derivatized and analyzed by GC/MS and GC/C/IRMS. In GC/MS and GC/C/IRMS analysis of rat urine, there was a statistically significant difference between urine from rat before administration of GHB and GHB rat urine (p < 0.05). In GC/MS analysis of human urine samples, there was no significant difference among human urine groups (negative control, suspects' urine, and victims' urine), but in GC/C/IRMS analysis of human urine samples, there was a statistically significant difference among human urine groups (p = 0.0001). Through these results, GC/C/IRMS can be more effective tool to identify endogenous and exogenous GHB in urine than GC/MS. This study can build a drug management system in forensic investigation agency and offer interpretation method to forensic science and court.
Collapse
Affiliation(s)
- Hyojeong Kim
- College of Pharmacy, Duksung Women's University, Seoul, 01369, South Korea.,Innovative Drug Center, Duksung Women's University, Seoul, South Korea
| | - Dong-Hun Lee
- Department of Marine Science and Convergent Technology, Hanyang University, Ansan, 15588, South Korea
| | - Ahra Go
- College of Pharmacy, Duksung Women's University, Seoul, 01369, South Korea
| | | | | | - Sanghwan In
- National Forensic Service, Wonju, South Korea
| | - Eunmi Kim
- National Forensic Service, Wonju, South Korea
| | - Hunjoo Lee
- CHEM.I.NET,Ltd, Room 302, 773-3, Mok-dong, Yangcheon-gu, Seoul, South Korea
| | - Kyung-Hoon Shin
- Department of Marine Science and Convergent Technology, Hanyang University, Ansan, 15588, South Korea.
| | - Eunyoung Han
- College of Pharmacy, Duksung Women's University, Seoul, 01369, South Korea. .,Innovative Drug Center, Duksung Women's University, Seoul, South Korea.
| |
Collapse
|
20
|
Busardò FP, Jones AW. Interpreting γ-hydroxybutyrate concentrations for clinical and forensic purposes. Clin Toxicol (Phila) 2018; 57:149-163. [PMID: 30307336 DOI: 10.1080/15563650.2018.1519194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION γ-Hydroxybutyric acid is an endogenous substance, a therapeutic agent, and a recreational drug of abuse. This psychoactive substance acts as a depressant of the central nervous system and is commonly encountered in clinical and forensic practice, including impaired drivers, poisoned patients, and drug-related intoxication deaths. OBJECTIVE The aim of this review is to assist clinical and forensic practitioners with the interpretation of γ-hydroxybutyric acid concentrations in blood, urine, and alternative biological specimens from living and deceased persons. METHODS The information sources used to prepare this review were PubMed, Scopus, and Web-of-Science. These databases were searched using keywords γ-hydroxybutyrate (GHB), blood, urine, alternative specimens, non-conventional biological matrices, saliva, oral fluid, sweat, hair, vitreous humor (VH), brain, cerebrospinal fluid (CSF), dried blood spots (DBS), breast milk, and various combinations thereof. The resulting 4228 references were screened to exclude duplicates, which left 1980 articles for further consideration. These publications were carefully evaluated by taking into account the main aims of the review and 143 scientific papers were considered relevant. Analytical methods: The analytical methods used to determine γ-hydroxybutyric acid in blood and other biological specimens make use of gas- or liquid-chromatography coupled to mass spectrometry. These hyphenated techniques are accurate, precise, and specific for their intended purposes and the lower limit of quantitation in blood and other specimens is 0.5 mg/L or less. Human pharmacokinetics: GHB is rapidly absorbed from the gut and distributes into the total body water compartment. Only a small fraction of the dose (1-2%) is excreted unchanged in the urine. The plasma elimination half-life of γ-hydroxybutyric acid is short, being only about 0.5-0.9 h, which requires timely sampling of blood and other biological specimens for clinical and forensic analysis. Endogenous concentrations of GHB in blood: GHB is both an endogenous metabolite and a drug of abuse, which complicates interpretation of the laboratory results of analysis. Moreover, the concentrations of GHB in blood and other specimens tend to increase after sampling, especially in autopsy cases. This requires the use of practical "cut-off" concentrations to avoid reporting false positive results. These cut-offs are different for different biological specimen types. Concentrations of GHB in clinical and forensic practice: As a recreational drug GHB is predominantly used by young males (94%) with a mean age of 27.1 years. The mean (median) and range of concentrations in blood from apprehended drivers was 90 mg/L (82 mg/L) and 8-600 mg/L, respectively. The concentration distributions in blood taken from living and deceased persons overlapped, although the mean (median) and range of concentrations were higher in intoxication deaths; 640 mg/L (280 mg/L) and 30-9200 mg/L, respectively. Analysis of GHB in alternative specimens: All biological fluids and tissue containing water are suitable for the analysis of GHB. Examples of alternative specimens discussed in this review are CSF, saliva, hair strands, breast milk, DBS, VH, and brain tissue. CONCLUSIONS Body fluids for the analysis of GHB must be obtained as quickly as possible after a poisoned patient is admitted to hospital or after a person is arrested for a drug-related crime to enhance chances of detecting the drug. The sampling of urine lengthens the window of detection by 3-4 h compared with blood samples, but with longer delays between last intake of GHB and obtaining specimens, hair strands, and/or nails might be the only option. In postmortem toxicology, the concentrations of drugs tend to be more stable in bladder urine, VH, and CSF compared with blood, because these sampling sites are protected from the spread of bacteria from the gut. Accordingly, the relationship between blood and urine concentrations of GHB furnishes useful information when drug intoxication deaths are investigated.
Collapse
Affiliation(s)
- Francesco Paolo Busardò
- a Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , Sapienza University of Rome , Rome , Italy
| | - Alan Wayne Jones
- b Department of Clinical Pharmacology , University of Linköping , Linköping , Sweden
| |
Collapse
|
21
|
Liu J, Deng Z, Zhu Z, Wang Y, Wang G, Sun YA, Zhu Y. Determination of γ-hydroxybutyrate in human urine samples by ion exclusion and ion exchange two-dimensional chromatography system. J Chromatogr A 2017; 1528:35-40. [DOI: 10.1016/j.chroma.2017.10.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/21/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
|
22
|
Mehling LM, Piper T, Spottke A, Heidbreder A, Young P, Madea B, Thevis M, Hess C. GHB-O-β-glucuronide in blood and urine is not a suitable tool for the extension of the detection window after GHB intake. Forensic Toxicol 2017. [DOI: 10.1007/s11419-016-0352-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
23
|
Microwave-assisted on-spot derivatization for gas chromatography–mass spectrometry based determination of polar low molecular weight compounds in dried blood spots. J Chromatogr A 2016; 1465:175-83. [DOI: 10.1016/j.chroma.2016.08.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/26/2022]
|
24
|
Wernli C, Finochiaro S, Volken C, Andresen-Streichert H, Buettler A, Gygax D, Salomons GS, Jansen EE, Ainslie GR, Vogel KR, Gibson KM. Targeted screening of succinic semialdehyde dehydrogenase deficiency (SSADHD) employing an enzymatic assay for γ-hydroxybutyric acid (GHB) in biofluids. Mol Genet Metab Rep 2016. [PMID: 28649510 PMCID: PMC5470939 DOI: 10.1016/j.ymgmr.2016.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
HYPOTHESIS An enzymatic assay for quantification of γ-hydroxybutyric acid (GHB) in biofluids can be employed for targeted screening of succinic semialdehyde dehydrogenase deficiency (SSADHD) in selected populations. RATIONALE We used a two-tiered study approach, in which the first study (proof of concept) examined 7 urine samples derived from patients with SSADHD and 5 controls, and the second study (feasibility study) examined a broader sample population of patients and controls, including plasma. OBJECTIVE Split samples of urine and plasma (anonymized) were evaluated by enzymatic assay, gas chromatography alone (proof of concept) and gas chromatography-mass spectrometry, and the results compared. METHOD Multiple detection methods have been developed to detect GHB. We evaluated an enzymatic assay which employs recombinant GHB dehydrogenase coupled to NADH production, the latter quantified on a Cobas Integra 400 Plus. Results: In our proof of concept study, we analyzed 12 urine samples (5 controls, 7 SSADHD), and in the feasibility study we evaluated 33 urine samples (23 controls, 10 SSADHD) and 31 plasma samples (14 controls, 17 SSADHD). The enzymatic assay carried out on a routine clinical chemistry analyzer was robust, revealing excellent agreement with instrumental methods in urine (GC-FID: r = 0.997, p ≤ 0.001; GC-MS: r = 0.99, p ≤ 0.001); however, the assay slightly over-estimated GHB levels in plasma, especially those in which GHB levels were low. Conversely, correlations for the enzymatic assay with comparator methods for higher plasma GHB levels were excellent (GC-MS; r = 0.993, p ≤ 0.001). CONCLUSION We have evaluated the capacity of this enzymatic assay to identify patients with SSADHD via quantitation of GHB. The data suggests that the enzymatic assay may be a suitable screening method to detect SSADHD in selected populations using urine. In addition, the assay can be used in basic research the elucidate the mechanism of the underlying disease or monitor GHB- levels for the evaluation of drug candidates. SYNOPSIS An enzymatic assay for GHB in biofluids was evaluated as a screening method for SSADHD and found to be reliable in urine, but in need of refinement for application to plasma.
Collapse
Key Words
- CV, coefficient of variation
- Enzymatic enzyme assay
- GABA, gamma-aminobutyric acid
- GC-FID, gas chromatography-flame ionization detector
- GC–MS, gas chromatography–mass spectrometry
- GHB, gamma-hydroxybutyrate (also γ-hydroxybutyric acid)
- GHBDH, GHB-dehydrogenase
- IDM, isotope dilution method
- LLOQ, lower limit of quantification
- LOD, limit of detection
- NADH, nicotinamide adenine dinucleotide, reduced form
- SSADHD, succinic semialdehyde dehydrogenase deficiency
- Succinic semialdehyde dehydrogenase
- Succinic semialdehyde dehydrogenase deficiency
- r, correlation coefficient (Pearson)
- γ-hydroxybutyric acid
Collapse
Affiliation(s)
- C Wernli
- University of Applied Sciences and Arts, Northwestern Switzerland School of Life Sciences, Institute for Chemistry and Bioanalytics, Switzerland
| | - S Finochiaro
- Bildungszentrum Gesundheit Basel-Stadt, Münchenstein, Switzerland.,Zentrallabor, Kantonsspital Baselland, Bruderholz, Switzerland
| | - C Volken
- Zentrallabor, Kantonsspital Baselland, Bruderholz, Switzerland
| | - H Andresen-Streichert
- University Medical Center Hamburg-Eppendorf Institute of Legal Medicine, Department of Toxicology, Hamburg, Germany
| | - A Buettler
- University of Applied Sciences and Arts Northwestern Switzerland School of Life Sciences, Institute for Chemistry and Bioanalytics Muttenz, Switzerland
| | - D Gygax
- University of Applied Sciences and Arts Northwestern Switzerland School of Life Sciences, Institute for Chemistry and Bioanalytics Muttenz, Switzerland
| | - G S Salomons
- Metabolic Unit, Department of Clinical Chemistry, VU University Mediscal Center, Neuroscience Campus, Amsterdam, The Netherlands
| | - E E Jansen
- Metabolic Unit, Department of Clinical Chemistry, VU University Mediscal Center, Neuroscience Campus, Amsterdam, The Netherlands
| | - G R Ainslie
- Division of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, WA, USA
| | - K R Vogel
- Division of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, WA, USA
| | - K M Gibson
- Division of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, WA, USA
| |
Collapse
|
25
|
Castro AL, Tarelho S, Dias M, Reis F, Teixeira HM. Comparison of endogenous GHB concentrations in blood and hair in death cases with emphasis on the post mortem interval. Int J Legal Med 2016; 130:959-965. [DOI: 10.1007/s00414-016-1321-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/15/2016] [Indexed: 01/10/2023]
|
26
|
Castro AL, Tarelho S, Dias M, Reis F, Teixeira HM. A fast and reliable method for GHB quantitation in whole blood by GC–MS/MS (TQD) for forensic purposes. J Pharm Biomed Anal 2016; 119:139-44. [DOI: 10.1016/j.jpba.2015.11.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
|
27
|
Mehling LM, Johansen SS, Wang X, Doberentz E, Madea B, Hess C. Drug facilitated sexual assault with lethal outcome: GHB intoxication in a six-year-old girl. Forensic Sci Int 2016; 259:e25-31. [DOI: 10.1016/j.forsciint.2015.12.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/17/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
|
28
|
Busardò FP, Jones AW. GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Curr Neuropharmacol 2016; 13:47-70. [PMID: 26074743 PMCID: PMC4462042 DOI: 10.2174/1570159x13666141210215423] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/01/2014] [Accepted: 10/25/2014] [Indexed: 11/29/2022] Open
Abstract
The illicit recreational drug of abuse, γ-hydroxybutyrate (GHB) is a potent central nervous
system depressant and is often encountered during forensic investigations of living and deceased
persons. The sodium salt of GHB is registered as a therapeutic agent (Xyrem®), approved in some
countries for the treatment of narcolepsy-associated cataplexy and (Alcover®) is an adjuvant
medication for detoxification and withdrawal in alcoholics. Trace amounts of GHB are produced
endogenously (0.5-1.0 mg/L) in various tissues, including the brain, where it functions as both a
precursor and a metabolite of the major inhibitory neurotransmitter γ-aminobutyric acid (GABA). Available information
indicates that GHB serves as a neurotransmitter or neuromodulator in the GABAergic system, especially via binding to
the GABA-B receptor subtype. Although GHB is listed as a controlled substance in many countries abuse still continues,
owing to the availability of precursor drugs, γ-butyrolactone (GBL) and 1,4-butanediol (BD), which are not regulated.
After ingestion both GBL and BD are rapidly converted into GHB (t½ ~1 min). The Cmax occurs after 20-40 min and
GHB is then eliminated from plasma with a half-life of 30-50 min. Only about 1-5% of the dose of GHB is recoverable in
urine and the window of detection is relatively short (3-10 h). This calls for expeditious sampling when evidence of drug
use and/or abuse is required in forensic casework. The recreational dose of GHB is not easy to estimate and a
concentration in plasma of ~100 mg/L produces euphoria and disinhibition, whereas 500 mg/L might cause death from
cardiorespiratory depression. Effective antidotes to reverse the sedative and intoxicating effects of GHB do not exist. The
poisoned patients require supportive care, vital signs should be monitored and the airways kept clear in case of emesis.
After prolonged regular use of GHB tolerance and dependence develop and abrupt cessation of drug use leads to
unpleasant withdrawal symptoms. There is no evidence-based protocol available to deal with GHB withdrawal, apart from
administering benzodiazepines.
Collapse
Affiliation(s)
- Francesco P Busardò
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Alan W Jones
- Department of Clinical Pharmacology, University of Linköping, Linköping, Sweden
| |
Collapse
|
29
|
Vaiano F, Serpelloni G, Furlanetto S, Palumbo D, Mari F, Fioravanti A, Bertol E. Determination of endogenous concentration of γ-hydroxybutyric acid (GHB) in hair through an ad hoc GC–MS analysis: A study on a wide population and influence of gender and age. J Pharm Biomed Anal 2016; 118:161-166. [DOI: 10.1016/j.jpba.2015.10.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 11/27/2022]
|
30
|
Mazina J, Saar-Reismaa P, Kulp M, Kaljurand M, Vaher M. Determination of γ-hydroxybutyric acid in saliva by capillary electrophoresis coupled with contactless conductivity and indirect UV absorbance detectors. Electrophoresis 2015; 36:3042-9. [DOI: 10.1002/elps.201500293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/24/2015] [Accepted: 09/16/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Jekaterina Mazina
- Department of Chemistry; Tallinn University of Technology; Tallinn Estonia
- NarTest AS; Tallinn Estonia
| | - Piret Saar-Reismaa
- Department of Chemistry; Tallinn University of Technology; Tallinn Estonia
| | - Maria Kulp
- Department of Chemistry; Tallinn University of Technology; Tallinn Estonia
| | - Mihkel Kaljurand
- Department of Chemistry; Tallinn University of Technology; Tallinn Estonia
| | - Merike Vaher
- Department of Chemistry; Tallinn University of Technology; Tallinn Estonia
| |
Collapse
|
31
|
Analysis of γ-hydroxy butyrate by combining capillary electrophoresis-indirect detection and wall dynamic coating: application to dried matrices. Anal Bioanal Chem 2015; 407:8893-901. [DOI: 10.1007/s00216-015-9051-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 01/22/2023]
|
32
|
Drogies T, Willenberg A, Ramshorn-Zimmer A, Weidhase L, Petros S, Hädrich C, Thiery J, Gries A, Bernhard M. Detection of gamma hydroxybutyrate in emergency department: Nice to have or a valuable diagnostic tool? Hum Exp Toxicol 2015; 35:785-92. [PMID: 26395197 DOI: 10.1177/0960327115606790] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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). CONCLUSION 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.
Collapse
Affiliation(s)
- T Drogies
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany
| | - A Willenberg
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany
| | - A Ramshorn-Zimmer
- Emergency Department, University Hospital of Leipzig, Leipzig, Germany
| | - L Weidhase
- Medical Intensive Care Unit, University Hospital of Leipzig, Leipzig, Germany
| | - S Petros
- Medical Intensive Care Unit, University Hospital of Leipzig, Leipzig, Germany
| | - C Hädrich
- Institute for Legal Medicine, University of Leipzig, Leipzig, Germany
| | - J Thiery
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany
| | - A Gries
- Emergency Department, University Hospital of Leipzig, Leipzig, Germany
| | - M Bernhard
- Emergency Department, University Hospital of Leipzig, Leipzig, Germany
| |
Collapse
|
33
|
Hanisch S, Stachel N, Skopp G. A potential new metabolite of gamma-hydroxybutyrate: sulfonated gamma-hydroxybutyric acid. Int J Legal Med 2015. [PMID: 26210636 DOI: 10.1007/s00414-015-1235-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Detection of gamma-hydroxybutyric acid (GHB) became crucial in many clinical and forensic settings due to its increasing use for recreational purposes and drug-facilitated sexual assault. Its narrow window of detection of about 3-12 h in urine represents a major problem. Analogous to ethyl glucuronide, the recently identified GHB-glucuronide exhibits a longer window of detection than the parent drug. It appeared reasonable that a sulfonated metabolite of GHB (GHB-SUL) will also be formed. Due to the lack of an appropriate standard, GHB was incubated with a human liver cytosolic fraction to produce GHB-SUL. Following development of a liquid chromatography/tandem mass spectrometry (LC-MS/MS) assay to measure GHB and GHB-SUL, authentic urine samples (n = 5) were tested for GHB-SUL. These investigations revealed detectable signals of both GHB and GHB-SUL, strongly indicating that GHB is not only glucuronidated but also sulfonated. Given that sulfonated metabolites generally have longer half-life times than the corresponding free drugs, GHB-SUL may serve as a biomarker of GHB misuse along with its glucuronide.
Collapse
Affiliation(s)
- Stephanie Hanisch
- Institute of Legal and Traffic Medicine, University Hospital, Voss-Str. 2, Heidelberg, 69115, Germany
| | - Nicole Stachel
- Institute of Legal and Traffic Medicine, University Hospital, Voss-Str. 2, Heidelberg, 69115, Germany.
| | - Gisela Skopp
- Institute of Legal and Traffic Medicine, University Hospital, Voss-Str. 2, Heidelberg, 69115, Germany.
| |
Collapse
|
34
|
Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use. Neurosci Biobehav Rev 2015; 53:52-78. [PMID: 25843781 DOI: 10.1016/j.neubiorev.2015.03.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 03/08/2015] [Accepted: 03/25/2015] [Indexed: 11/22/2022]
|
35
|
Dziadosz M. γ-Hydroxybutyrate analysis in human serum with liquid chromatography–tandem mass spectrometry on the basis of MS3 mass transition. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 986-987:8-11. [DOI: 10.1016/j.jchromb.2015.01.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
|
36
|
Sadones N, Archer JRH, Ingels ASME, Dargan PI, Wood DM, Wood M, Neels H, Lambert WE, Stove CP. Do capillary dried blood spot concentrations of gamma-hydroxybutyric acid mirror those in venous blood? A comparative study. Drug Test Anal 2015; 7:336-40. [DOI: 10.1002/dta.1760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/05/2014] [Accepted: 11/05/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Nele Sadones
- Laboratory of Toxicology; Ghent University; Ghent Belgium
| | - John R. H. Archer
- Guy's and St Thomas' NHS Foundation Trust; Clinical Toxicology; London UK
| | - Ann-Sofie M. E. Ingels
- Laboratory of Toxicology; Ghent University; Ghent Belgium
- Laboratory of Toxicology; National Institute for Criminalistics and Criminology; Brussels Belgium
| | - Paul I. Dargan
- Guy's and St Thomas' NHS Foundation Trust; Clinical Toxicology; London UK
- King's College London; London UK
| | - David M. Wood
- Guy's and St Thomas' NHS Foundation Trust; Clinical Toxicology; London UK
- King's College London; London UK
| | - Michelle Wood
- Waters Corporation; MS Technologies Centre; Manchester UK
| | - Hugo Neels
- Toxicological Centre; University of Antwerp; Wilrijk Belgium
| | | | | |
Collapse
|
37
|
Castro AL, Dias M, Reis F, Teixeira HM. Gamma-hydroxybutyric acid endogenous production and post-mortem behaviour – The importance of different biological matrices, cut-off reference values, sample collection and storage conditions. J Forensic Leg Med 2014; 27:17-24. [DOI: 10.1016/j.jflm.2014.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 11/27/2022]
|
38
|
Port A, Olszewski H, Walther U, Büttner A, Rentsch D. Nachweis von γ-Hydroxybuttersäure bei γ-Butyrolacton-Abhängigkeit. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0966-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
39
|
Andresen-Streichert H, Jensen P, Kietzerow J, Schrot M, Wilke N, Vettorazzi E, Mueller A, Iwersen-Bergmann S. Endogenous gamma-hydroxybutyric acid (GHB) concentrations in post-mortem specimens and further recommendation for interpretative cut-offs. Int J Legal Med 2014; 129:57-68. [DOI: 10.1007/s00414-014-1051-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
|
40
|
Kang S, Oh SM, Chung KH, Lee S. A surrogate analyte-based LC-MS/MS method for the determination of γ-hydroxybutyrate (GHB) in human urine and variation of endogenous urinary concentrations of GHB. J Pharm Biomed Anal 2014; 98:193-200. [PMID: 24929871 DOI: 10.1016/j.jpba.2014.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 12/26/2022]
Abstract
γ-Hydroxybutyrate (GHB) is a drug of abuse with a strong anesthetic effect; however, proving its ingestion through the quantification of GHB in biological specimens is not straightforward due to the endogenous presence of GHB in human blood, urine, saliva, etc. In the present study, a surrogate analyte approach was applied to accurate quantitative determination of GHB in human urine using liquid chromatography-tandem mass spectrometry (LC-MS/MS) in order to overcome this issue. For this, (2)H6-GHB and (13)C2-dl-3-hydroxybutyrate were used as a surrogate standard and as an internal standard, respectively, and parallelism between the surrogate analyte approach and standard addition was investigated at the initial step. The validation results proved the method to be selective, accurate, and precise, with acceptable linearity within calibration ranges (0.1-1μg/ml). The limit of detection and the limit of quantification of (2)H6-GHB were 0.05 and 0.1μg/ml, respectively. No significant variations were observed among urine matrices from different sources. The stability of (2)H6-GHB was satisfactory under sample storage and in-process conditions. However, in vitro production of endogenous GHB was observed when the urine sample was kept under the in-process condition for 4h and under the storage conditions of 4 and -20°C. In order to facilitate the practical interpretation of urinary GHB, endogenous GHB was accurately measured in urine samples from 79 healthy volunteers using the surrogate analyte-based LC-MS/MS method developed in the present study. The unadjusted and creatinine-adjusted GHB concentrations in 74 urine samples with quantitative results ranged from 0.09 to 1.8μg/ml and from 4.5 to 530μg/mmol creatinine, respectively. No significant correlation was observed between the unadjusted and creatinine-adjusted GHB concentrations. The urinary endogenous GHB concentrations were affected by gender and age while they were not significantly influenced by habitual smoking, alcohol drinking, or caffeine-containing beverage drinking.
Collapse
Affiliation(s)
- Soyoung Kang
- College of Pharmacy, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 704-701, Republic of Korea
| | - Seung Min Oh
- Hoseo Toxicology Research Center, Hoseo University, 20 Hoseo-ro 79 beon-gil, Asan, Chungcheongnam-do 336-795, Republic of Korea
| | - Kyu Hyuck Chung
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 440-746, Republic of Korea
| | - Sooyeun Lee
- College of Pharmacy, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 704-701, Republic of Korea.
| |
Collapse
|
41
|
Screening and confirmation methods for GHB determination in biological fluids. Anal Bioanal Chem 2014; 406:3553-77. [PMID: 24500753 DOI: 10.1007/s00216-013-7586-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/09/2013] [Accepted: 12/14/2013] [Indexed: 10/25/2022]
Abstract
The purpose of this review is to provide a comprehensive overview of reported methods for screening and confirmation of the low-molecular-weight compound and drug of abuse gamma-hydroxybutyric acid (GHB) in biological fluids. The polarity of the compound, its endogenous presence, its rapid metabolism after ingestion, and its instability during storage (de novo formation and interconversion between GHB and its lactone form gamma-butyrolactone) are challenges for the analyst and for interpretation of a positive result. First, possible screening procedures for GHB are discussed, including colorimetric, enzymatic, and chromatography-based procedures. Confirmation methods for clinical and forensic cases mostly involve gas chromatography (coupled to mass spectrometry), although liquid chromatography and capillary zone electrophoresis have also been used. Before injection, sample-preparation techniques include (a combination of) liquid-liquid, solid-phase, or headspace extraction, and chemical modification of the polar compound. Also simple "dilute-and-shoot" may be sufficient for urine or serum. Advantages, limitations, and trends are discussed.
Collapse
|
42
|
Sørensen LK, Rittig NF, Holmquist EF, Jørgensen KA, Jørgensen JOL, Møller N, Johannsen M. Simultaneous determination of β-hydroxybutyrate and β-hydroxy-β-methylbutyrate in human whole blood using hydrophilic interaction liquid chromatography electrospray tandem mass spectrometry. Clin Biochem 2013; 46:1877-83. [PMID: 23994603 DOI: 10.1016/j.clinbiochem.2013.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/09/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES For the quantification of β-hydroxybutyrate (BHB) and β-hydroxy-β-methylbutyrate (HMB) in human whole blood, a method using hydrophilic interaction liquid chromatography tandem mass spectrometry (HILIC-MS/MS) was developed, which does not require chemical modification of the analytes. DESIGN AND METHODS Samples were deproteinised by a mixture of methanol and acetonitrile, and the extracts were cleaned-up using both polymeric strong cation exchange and strong anion exchange sorbents. The analytes and their structural isomers were separated using a column with a zwitterionic stationary phase. Isotope dilution of both analytes was used for quantitative analysis. RESULTS Separation of BHB from isobaric interferences was achieved through chromatography. The relative intra-laboratory reproducibility standard deviations were better than 10% for blood samples at concentration levels of 10-20μM BHB and 1μM HMB and better than 5% at concentration levels 10 times higher. The mean true extraction recoveries were close to 100%. The trueness expressed as the relative bias of test results was within ±5% at concentration levels of 10-1000μM BHB and 1-20μM HMB. The lower limits of quantification were estimated to be 3μM for BHB and 0.4μM for HMB. CONCLUSIONS A simple and highly sensitive and selective HILIC-MS/MS method was developed that is suitable for the quantification of BHB and HMB in whole blood.
Collapse
Affiliation(s)
- Lambert K Sørensen
- Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
| | | | | | | | | | | | | |
Collapse
|
43
|
Schröck A, Hari Y, König S, Auwärter V, Schürch S, Weinmann W. Pharmacokinetics of GHB and detection window in serum and urine after single uptake of a low dose of GBL - an experiment with two volunteers. Drug Test Anal 2013; 6:363-6. [DOI: 10.1002/dta.1498] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/17/2013] [Accepted: 04/21/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Alexandra Schröck
- Institute of Forensic Medicine, Forensic Toxicology and Chemistry; University of Bern; Switzerland
| | - Yvonne Hari
- Institute of Forensic Medicine, Forensic Toxicology and Chemistry; University of Bern; Switzerland
| | - Stefan König
- Institute of Forensic Medicine, Forensic Toxicology and Chemistry; University of Bern; Switzerland
| | - Volker Auwärter
- Institute of Forensic Medicine; University Medical Center; Freiburg Germany
| | - Stefan Schürch
- Department of Chemistry and Biochemistry; University of Bern; Switzerland
| | - Wolfgang Weinmann
- Institute of Forensic Medicine, Forensic Toxicology and Chemistry; University of Bern; Switzerland
| |
Collapse
|
44
|
Determination of gamma-hydroxybutyric acid in biofluids using a one-step procedure with “in-vial” derivatization and headspace-trap gas chromatography–mass spectrometry. J Chromatogr A 2013; 1296:84-92. [DOI: 10.1016/j.chroma.2013.04.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 01/15/2023]
|
45
|
Andresen-Streichert H, Jungen H, Gehl A, Muller A, Iwersen-Bergmann S. Uptake of Gamma-Valerolactone--Detection of Gamma-Hydroxyvaleric Acid in Human Urine Samples. J Anal Toxicol 2013; 37:250-4. [DOI: 10.1093/jat/bkt013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
Ingels ASME, Hertegonne KB, Lambert WE, Stove CP. Feasibility of following up gamma-hydroxybutyric acid concentrations in sodium oxybate (Xyrem®)-treated narcoleptic patients using dried blood spot sampling at home: an exploratory study. CNS Drugs 2013; 27:233-7. [PMID: 23463369 DOI: 10.1007/s40263-013-0050-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gamma-hydroxybutyric acid (GHB), well known as a party drug, especially in Europe, is also legally used (sodium oxybate, Xyrem(®)) to treat a rare sleep disorder, narcolepsy with cataplexy. This exploratory study was set up to measure GHB concentrations in dried blood spots (DBS) collected by narcoleptic patients treated with sodium oxybate. Intra- and inter-individual variation in clinical effects following sodium oxybate administration has been reported. The use of DBS as a sampling technique, which is stated to be easy and convenient, may provide a better insight into GHB concentrations following sodium oxybate intake in a real-life setting. OBJECTIVE The aim was twofold: evaluation of the applicability of a recently developed DBS-based gas chromatography-mass spectrometry (GC-MS) method, and of the feasibility of the sampling technique in an ambulant setting. METHODS Seven narcoleptic patients being treated with sodium oxybate at the Department for Respiratory Diseases of Ghent University Hospital were asked to collect DBS approximately 20 min after the first sodium oxybate (Xyrem(®); UCB Pharma Ltd, Brussels, Belgium) intake on a maximum of 7 consecutive days. Using an automatic lancet, patients pricked their fingertip and, after wiping off the first drop of blood, subsequent drops were collected on a DBS card. The DBS cards were sent to the laboratory by regular mail and, before analysis, were visually inspected to record DBS quality (large enough, symmetrically spread on the filter paper with even colouration on both sides of the filter paper). RESULTS Of the seven patients, three patients succeeded to collect five series of DBS, one patient decided to cease participation because of nausea, one was lost during follow-up and two patients started falling asleep almost immediately after the intake of sodium oxybate. Analysing the DBS in duplicate resulted in acceptable within-DBS card precision. DBS with acceptable quality were obtained by patients without supervision. CONCLUSION Our results demonstrate the acceptable precision of the complete procedure, from sampling at home to quantitative analysis in the laboratory. Given the intra- and inter-individual variability in clinical effects seen with sodium oxybate, the easy adaptation of DBS sampling opens the possibility of following up GHB concentrations in patients in real-life settings in future studies.
Collapse
Affiliation(s)
- Ann-Sofie M E Ingels
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Harelbekestraat 72, 9000, Ghent, Belgium
| | | | | | | |
Collapse
|
47
|
Sørensen LK, Hasselstrøm JB. A hydrophilic interaction liquid chromatography electrospray tandem mass spectrometry method for the simultaneous determination of γ-hydroxybutyrate and its precursors in forensic whole blood. Forensic Sci Int 2012; 222:352-9. [DOI: 10.1016/j.forsciint.2012.07.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/17/2012] [Accepted: 07/28/2012] [Indexed: 11/30/2022]
|
48
|
Estimation of gamma-hydroxybutyrate (GHB) co-consumption in serum samples of drivers positive for amphetamine or ecstasy. Forensic Sci Int 2012; 221:98-101. [DOI: 10.1016/j.forsciint.2012.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/05/2012] [Accepted: 04/07/2012] [Indexed: 12/28/2022]
|
49
|
Chèze M, Hoizey G, Deveaux M, Muckensturm A, Vayssette F, Billault F, Pépin G. Une série de nouveaux cas d’intoxications par le GHB ou la GBL. Dosages dans le sang, l’urine et les phanères. ACTA ACUST UNITED AC 2012. [DOI: 10.1051/ata/2012005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
50
|
Grenier V, Huppé G, Lamarche M, Mireault P. Enzymatic assay for GHB determination in forensic matrices. J Anal Toxicol 2012; 36:523-8. [PMID: 22722059 DOI: 10.1093/jat/bks053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Current procedures for the determination of gamma-hydroxybutyric acid (GHB) require time-consuming extraction and derivatization steps before chromatographic detection, making a high-throughput alternative desirable. Bühlmann Laboratories offers an enzymatic assay for the quantitative determination of GHB in urine and serum. We report the adaptation of this photometric assay to the Thermo Scientific MGC-240 analyzer and its use in the determination of GHB in forensic matrices including urine, whole blood and vitreous humour. Most matrices require only a brief centrifugation before analysis, while blood requires an additional protein precipitation step. A variety of cases (sexual assaults, impaired drivers and death investigations) have been analyzed alongside the gas chromatography-mass spectrometry (GC-MS) reference method. Correlation with the GC-MS has been found to be acceptable, with no false negatives and few false positives, although postmortem samples appear more prone to testing false positive than do antemortem samples. Simple sample preparation and high throughput allow for a significant reduction in analysis time relative to chromatographic methods. This assay is used as a screening method in our laboratory, with a quantitative GC-MS method serving for the confirmation of positive results. To our knowledge, this represents the first evaluation of an enzymatic assay for GHB in a forensic context.
Collapse
|