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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.
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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
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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]
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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.
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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
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Schütz L, Sixel-Döring F, Hermann W. Management of Sleep Disturbances in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2029-2058. [PMID: 35938257 PMCID: PMC9661340 DOI: 10.3233/jpd-212749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 06/07/2023]
Abstract
Parkinson's disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.
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Affiliation(s)
- Lukas Schütz
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
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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.
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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
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