1
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Kemperman RH, Ganetzky RD, Master SR. Development and validation of a multiplexed LC-MS/MS ketone body assay for clinical diagnostics. J Mass Spectrom Adv Clin Lab 2024; 31:49-58. [PMID: 38375486 PMCID: PMC10874984 DOI: 10.1016/j.jmsacl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/27/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Objectives Ketone bodies (KBs) serve as important energy sources that spare glucose, providing the primary energy for cardiac muscle, skeletal muscle during aerobic exercise, and the brain during periods of catabolism. The levels and relationships between the KBs are critical indicators of metabolic health and disease. However, challenges in separating isomeric KBs and concerns about sample stability have previously limited their clinical measurement. Methods A novel 6.5-minute liquid chromatography-mass spectrometry-based assay was developed, enabling the precise measurement of alpha-, beta- and gamma-hydroxybutyrate, beta-hydroxyisobutyrate, and acetoacetate. This method was fully validated for human serum and plasma samples by investigating extraction efficiency, matrix effects, accuracy, recovery, intra- and inter-precision, linearity, lower limit of quantitation (LLOQ), carryover, specificity, stability, and more. From 107 normal samples, reference ranges were established for all analytes and the beta-hydroxybutyrate/acetoacetate ratio. Results All five analytes were adequately separated chromatographically. An extraction efficiency between 80 and 120 % was observed for all KBs. Accuracy was evaluated through spike and recovery using 10 random patient samples, with an average recovery of 85-115 % for all KBs and a coefficient of variation of ≤ 3 %. Coefficients of variation for intra- and inter-day imprecision were < 5 %, and the total imprecision was < 10 %. No significant interferences were observed. Specimens remained stable for up to 6 h on ice or 2 h at room temperature. Conclusions The developed method is highly sensitive and robust. It has been validated for use with human serum and plasma, overcoming stability concerns and providing a reliable and efficient quantitative estimation of ketone bodies.
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Affiliation(s)
| | - Rebecca D. Ganetzky
- Children’s Hospital of Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Stephen R. Master
- Children’s Hospital of Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, PA, United States
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2
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Schulz K, Helms H, Janich A. Full evaporation headspace technique with gas chromatography as a microchemical method for the rapid determination of gamma-hydroxybutyric acid (GHB) in serum samples. Microchem J 2022. [DOI: 10.1016/j.microc.2022.107483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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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.
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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,
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4
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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]
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5
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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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6
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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.
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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.
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7
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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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8
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Wille SMR, Van Dijck K, Van Assche A, Di Fazio V, Ramiréz-Fernandéz MDM, Vanvooren V, Samyn N. The Interest of a Systematic Toxicological Analysis Combined with Forensic Advice to Improve the Judicial Investigation and Final Judgment in Drug Facilitated Sexual Assault Cases. Pharmaceuticals (Basel) 2021; 14:ph14050432. [PMID: 34064432 PMCID: PMC8147760 DOI: 10.3390/ph14050432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 11/25/2022] Open
Abstract
The conviction rate in drug facilitated sexual assault (DFSA) cases is known to be very low. In addition, the potential impact of toxicological results on the case is often not well understood by the judicial authorities. The aims of this study were (1) to obtain more knowledge concerning the prevalence of incapacitating substances in DFSA cases, (2) to create a more efficient DFSA analysis strategy taking background information into account, and (3) to evaluate the potential impact of systematic toxicological analysis (STA) on the final judicial outcome. This small-scale epidemiological study (n = 79) demonstrates that ‘commonly-used’ illicit drugs, psychoactive medicines and ethanol are more prevalent in DFSA cases in contrast to the highly mediatized date rape drugs. Additionally, via case examples, the interest of performing STA—to prove incapacitation of the victim—in judicial procedures with mutual-consent discussions has been demonstrated as it led to increased convictions. However, more attention has to be paid to ensure a short sampling delay and to get more accurate information from the medical treatment of the alleged victim. This will improve the interpretation of the toxicological analysis and thus its applicability in a DFSA case. The future is multi-disciplinary and will certainly lead to an efficient and more cost-effective DFSA approach in which STA can impact the final judgment.
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Affiliation(s)
- Sarah M. R. Wille
- Unit Toxicology, National Institute of Criminalistics and Criminology (NICC), 1120 Brussels, Belgium; (V.D.F.); (M.d.M.R.-F.); (N.S.)
- Correspondence:
| | - Karolien Van Dijck
- Unit Forensic Advice, National Institute of Criminalistics and Criminology (NICC), 1120 Brussels, Belgium; (K.V.D.); (A.V.A.)
| | - Antje Van Assche
- Unit Forensic Advice, National Institute of Criminalistics and Criminology (NICC), 1120 Brussels, Belgium; (K.V.D.); (A.V.A.)
| | - Vincent Di Fazio
- Unit Toxicology, National Institute of Criminalistics and Criminology (NICC), 1120 Brussels, Belgium; (V.D.F.); (M.d.M.R.-F.); (N.S.)
| | - Maria del Mar Ramiréz-Fernandéz
- Unit Toxicology, National Institute of Criminalistics and Criminology (NICC), 1120 Brussels, Belgium; (V.D.F.); (M.d.M.R.-F.); (N.S.)
| | - Vanessa Vanvooren
- Unit DNA Analysis, National Institute of Criminalistics and Criminology (NICC), 1120 Brussels, Belgium;
| | - Nele Samyn
- Unit Toxicology, National Institute of Criminalistics and Criminology (NICC), 1120 Brussels, Belgium; (V.D.F.); (M.d.M.R.-F.); (N.S.)
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9
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Davis KE, Hickey LD, Goodpaster JV. Detection of ɣ-hydroxybutyric acid (GHB) and ɣ-butyrolactone (GBL) in alcoholic beverages via total vaporization solid-phase microextraction (TV-SPME) and gas chromatography-mass spectrometry. J Forensic Sci 2021; 66:846-853. [PMID: 33400824 DOI: 10.1111/1556-4029.14660] [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: 09/06/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
Total Vaporization Solid-Phase Microextraction (TV-SPME) relies on the same technique as standard SPME but completely vaporizes a sample extract, and analytes are sorbed directly from the vapor phase. On-fiber derivatization may also be performed using TV-SPME, where the fiber is first exposed to the headspace of a vial containing the derivatization agent, then exposed to a new vial containing the sample. ɣ-Hydroxybutyric acid (GHB) and ɣ-butyrolactone (GBL) are drugs of concern in that they may be used in drug facilitated sexual assault by surreptitiously spiking them into a victim's beverage. These drugs cause sedation, memory loss, and are difficult to detect in biological samples. One challenge in their analysis is that they can interconvert in aqueous samples, which was demonstrated in samples allowed to stand at room temperature for long periods. A volume study of GBL in water was performed with volumes ranging from 1 to 10,000 µl to compare the efficacy of TV-SPME, headspace SPME, and immersion SPME. Lastly, water, beer, wine, liquor, and mixed drinks were spiked with either GHB or GBL with realistic concentrations (mg/ml) and microliter quantities were analyzed using a TV-SPME Gas Chromatography-Mass Spectrometry method. The GBL volume study demonstrated an increased sensitivity in GBL detection when TV-SPME was utilized. Additionally, GHB and GBL were identified in various beverages at realistic concentrations. Overall, TV-SPME is beneficial because it requires no sample preparation and uses smaller sample volumes than immersion and headspace SPME.
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Affiliation(s)
- Kymeri E Davis
- Department of Chemistry & Chemical Biology, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
| | - Logan D Hickey
- Forensic & Investigative Sciences, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
| | - John V Goodpaster
- Department of Chemistry & Chemical Biology, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA.,Forensic & Investigative Sciences, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
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10
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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
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11
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Marinelli E, Beck R, Malvasi A, Faro AFL, Zaami S. Gamma-hydroxybutyrate abuse: pharmacology and poisoning and withdrawal management. Arh Hig Rada Toksikol 2020; 71:19-26. [PMID: 32597141 PMCID: PMC7837237 DOI: 10.2478/aiht-2020-71-3314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/01/2019] [Accepted: 03/01/2020] [Indexed: 12/19/2022] Open
Abstract
Gamma-hydroxybutyrate (GHB) is a central nervous system depressant primarily used as a recreational drug of abuse, but also for the treatment of narcolepsy with cataplexy in adult patients and as an adjuvant for control of alcohol withdrawal syndrome. The main aim of this review is to summarise updated knowledge about GHB pharmacokinetics and pharmacodynamics, acute poisoning, and clinical features of GHB withdrawal syndrome, its diagnosis and medical treatment. The most common clinical signs and symptoms of acute poisoning include sleepiness to deep coma, bradycardia, hypotension, and respiratory failure. Therapy is essentially supportive and based on continuous monitoring of vital signs. GHB withdrawal syndrome shares patterns with other withdrawal syndromes such as alcohol withdrawal and is sometimes difficult to distinguish, especially if toxicological tests are GHB-negative or cannot be performed. There are no official detoxification protocols for GHB withdrawal syndrome, but its therapy is based on benzodiazepine. When benzodiazepine alone is not effective, it can be combined with barbiturates or antipsychotics. Information about abuse and distribution of GHB and its precursors/analogues among the general population is still limited. Their prompt identification is therefore crucial in conventional and non-conventional biological matrices, the latter in particular, to clarify all the issues around this complex molecule.
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Affiliation(s)
- Enrico Marinelli
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Renata Beck
- Department of Anaesthesia, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy
| | - Alfredo Fabrizio Lo Faro
- Section of Legal Medicine, Department of Excellence SBSP, University “Politecnica delle Marche” of Ancona, Ancona, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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12
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Desharnais B, Lajoie MJ, Laquerre J, Savard S, Mireault P, Skinner CD. A Tool for Automatic Correction of Endogenous Concentrations: Application to BHB Analysis by LC-MS-MS and GC-MS. J Anal Toxicol 2020; 43:512-519. [PMID: 31141151 DOI: 10.1093/jat/bkz024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/06/2019] [Accepted: 03/29/2019] [Indexed: 12/15/2022] Open
Abstract
Several substances relevant for forensic toxicology purposes have an endogenous presence in biological matrices: beta-hydroxybutyric acid (BHB), gamma-hydroxybutyric acid (GHB), steroids and human insulin, to name only a few. The presence of significant amounts of these endogenous substances in the biological matrix used to prepare calibration standards and quality control samples (QCs) can compromise validation steps and quantitative analyses. Several approaches to overcome this problem have been suggested, including using an analog matrix or analyte, relying entirely on standard addition analyses for these analytes, or simply ignoring the endogenous contribution provided that it is small enough. Although these approaches side-step the issue of endogenous analyte presence in spiked matrix-matched samples, they create serious problems with regards to the accuracy of the analyses or production capacity. We present here a solution that addresses head-on the problem of endogenous concentrations in matrices used for calibration standards and quality control purposes. The endogenous analyte concentration is estimated via a standard-addition type process. This estimated concentration, plus the spiked concentration are then used as the de facto analyte concentration present in the sample. These de facto concentrations are then used in data analysis software (MultiQuant, Mass Hunter, etc.) as the sample's concentration. This yields an accurate quantification of the analyte, free from interference of the endogenous contribution. This de facto correction has been applied in a production setting on two BHB quantification methods (GC-MS and LC-MS-MS), allowing the rectification of BHB biases of up to 30 μg/mL. The additional error introduced by this correction procedure is minimal, although the exact amount will be highly method-dependent. The endogenous concentration correction process has been automated with an R script. The final procedure is therefore highly efficient, only adding four mouse clicks to the data analysis operations.
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Affiliation(s)
- Brigitte Desharnais
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, Montréal, Québec, Canada.,Concordia University, Department of Chemistry & Biochemistry, 7141 Sherbrooke Street West, Montréal, Québec, Canada
| | - Marie-Jo Lajoie
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, Montréal, Québec, Canada
| | - Julie Laquerre
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, Montréal, Québec, Canada
| | - Stéphanie Savard
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, Montréal, Québec, Canada
| | - Pascal Mireault
- Laboratoire de sciences judiciaires et de médecine légale, Department of Toxicology, 1701 Parthenais Street, Montréal, Québec, Canada
| | - Cameron D Skinner
- Concordia University, Department of Chemistry & Biochemistry, 7141 Sherbrooke Street West, Montréal, Québec, Canada
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13
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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.
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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.
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14
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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.
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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
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15
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Bühler T, Schmid Y, Liechti ME. [Knockout Drugs: Diagnostics in the Emergency Unit and Clinical Practice]. PRAXIS 2019; 108:869-876. [PMID: 31571536 DOI: 10.1024/1661-8157/a003306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Knockout Drugs: Diagnostics in the Emergency Unit and Clinical Practice Abstract. Every now and then, physicians are challenged with date rape drugs. If there is a suspicion of substance administration, the question of involving forensic medicine is commonly raised. In obscure situations or questionable offences, however, patients may wish for an initial diagnosis in the emergency department or the private practice. The physicians are often greatly challenged by the variety of substances, the limited analytical methods and difficulties with the interpretion of results. The major goal of this article is to present diagnostic options including their limitations. An overview of frequently involved substances is provided. Particular focus will be placed on practical aspects, including questions regarding pre-analytics and health insurance coverage.
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Affiliation(s)
- Tim Bühler
- Abteilung für Klinische Pharmakologie & Toxikologie, Universitätsspital Basel
| | - Yasmin Schmid
- Abteilung für Klinische Pharmakologie & Toxikologie, Universitätsspital Basel
| | - Matthias E Liechti
- Abteilung für Klinische Pharmakologie & Toxikologie, Universitätsspital Basel
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16
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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.
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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.
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17
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Toxicological findings in 1000 cases of suspected drug facilitated sexual assault in the United States. J Forensic Leg Med 2019; 61:56-64. [DOI: 10.1016/j.jflm.2018.11.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 11/23/2022]
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18
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Isakov VD, Gorbacheva TV, Fokin MB, Saigushkin NV. [The influence of the packaging on the storage qualities of the volatile substances]. Sud Med Ekspert 2018; 61:25-30. [PMID: 30307434 DOI: 10.17116/sudmed20186105125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to evaluate the storage qualities of the acetone and ethanol aqueous solutions kept in the polyethylene flasks, polypropylene and glass tubes that were stored under different environmental temperature. It was shown that the acetone aqueous solution better retained its properties when stored in glass vials at room temperature as well as at 0° C and 4° C. The most pronounced decrease of acetone concentrations (from 70 up to 95%) was documented after its storage in the polyethylene flasks. The ethanol concentration fell down by 40% when stored in polyethylene flasks at room temperature.
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Affiliation(s)
- V D Isakov
- Saint-Petersburg state budgetary institution 'Bureau of Forensic Medical Expertise', Saint-Petersburg, Russia, 195067; Department of Forensic Medicine, I.I. Mechnikov North-Western State Medical University, Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, 195067
| | - T V Gorbacheva
- Saint-Petersburg state budgetary institution 'Bureau of Forensic Medical Expertise', Saint-Petersburg, Russia, 195067
| | - M B Fokin
- Saint-Petersburg state budgetary institution 'Bureau of Forensic Medical Expertise', Saint-Petersburg, Russia, 195067
| | - N V Saigushkin
- Saint-Petersburg state budgetary institution 'Bureau of Forensic Medical Expertise', Saint-Petersburg, Russia, 195067
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19
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Medical Emergencies Related to Ethanol and Illicit Drugs at an Annual, Nocturnal, Indoor, Electronic Dance Music Event. Prehosp Disaster Med 2017; 33:71-76. [PMID: 29284546 DOI: 10.1017/s1049023x17007099] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction Medical problems are frequently encountered during electronic dance music (EDM) events. Problem There are uncertainties about the frequencies and severity of intoxications with different types of recreational drugs: ethanol, "classical" illicit party drugs, and new psychoactive substances (NPS). METHODS Statistical data on the medical problems encountered during two editions of an indoor electronic dance event with around 30,000 attendants were retrieved from the Belgian Red Cross (Mechelen, Belgium) database. Data on drug use were prospectively collected from the patient (or a bystander), the clinical presentation, and/or toxicological screening. RESULTS In the on-site medical station, 487 patients were treated (265 in 2013 and 222 in 2014). The most frequent reasons were trauma (n=171), headache (n=36), gastro-intestinal problems (n=44), and intoxication (n=160). Sixty-nine patients were transferred to a hospital, including 53 with severe drug-related symptoms. Analysis of blood samples from 106 intoxicated patients detected ethanol in 91.5%, 3,4-methylenedioxymethamphetamine (MDMA) in 34.0%, cannabis in 30.2%, cocaine in 7.5%, amphetamine in 2.8%, and gamma-hydroxybutyric acid (GHB) in 0.9% of patients (alone or in combination). In only six of the MDMA-positive cases, MDMA was the sole substance found. In 2014, the neuroleptic drug clozapine was found in three cases and ketamine in one. Additional analyses for NPS were performed in 20 cases. Only in one agitated patient, the psychedelic phenethylamines 25B-NBOMe and 25C-NBOMe were found. CONCLUSIONS At this particular event, recreational drug abuse necessitated on-site medical treatment in one out of 350 attendants and a hospital transfer in one out of 1,000. Ethanol remains the most frequently abused (legal) drug, yet classical illicit recreational drugs are also frequently (co-) ingested. The most worrying observation was high-risk poly-drug use, especially among MDMA users. Regarding NPS, the number of cases was low and the clinical presentations were rather mild. It should be stressed that these observations only apply to this particular event and cannot be generalized to other EDM events. Calle P , Sundahl N , Maudens K , Wille SMR , Van Sassenbroeck D , De Graeve K , Gogaert S , De Paepe P , Devriese D , Arno G , Blanckaert P . Medical emergencies related to ethanol and illicit drugs at an annual, nocturnal, indoor, electronic dance music event. Prehosp Disaster Med. 2018;33(1):71-76.
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20
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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]
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21
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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: 130] [Impact Index Per Article: 16.3] [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.
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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
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22
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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]
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23
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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.
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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
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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]
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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
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26
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The role of alkylsilyl derivatization techniques in the analysis of illicit drugs by gas chromatography. Microchem J 2015. [DOI: 10.1016/j.microc.2014.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Jagerdeo E, Montgomery MA, LeBeau MA. An Improved Method for the Analysis of GHB in Human Hair by Liquid Chromatography Tandem Mass Spectrometry†. J Anal Toxicol 2014; 39:83-8. [DOI: 10.1093/jat/bku130] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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]
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29
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Busardò FP, Bertol E, Vaiano F, Baglio G, Montana A, Barbera N, Zaami S, Romano G. Post mortem concentrations of endogenous gamma hydroxybutyric acid (GHB) and in vitro formation in stored blood and urine samples. Forensic Sci Int 2014; 243:144-8. [DOI: 10.1016/j.forsciint.2014.07.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 06/24/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
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30
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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]
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31
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Bertol E, Mari F, Vaiano F, Romano G, Zaami S, Baglìo G, Busardò FP. Determination of GHB in human hair by HPLC-MS/MS: Development and validation of a method and application to a study group and three possible single exposure cases. Drug Test Anal 2014; 7:376-84. [DOI: 10.1002/dta.1679] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Elisabetta Bertol
- Department of Health Sciences, Forensic Toxicology Division; University of Florence; Italy
| | - Francesco Mari
- Department of Health Sciences, Forensic Toxicology Division; University of Florence; Italy
| | - Fabio Vaiano
- Department of Health Sciences, Forensic Toxicology Division; University of Florence; Italy
| | - Guido Romano
- Department ‘G.F. Ingrassia’, Laboratory of Forensic Toxicology; University of Catania; Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences; Sapienza University of Rome; Viale Regina Elena 336 00161 Rome Italy
| | | | - Francesco Paolo Busardò
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences; Sapienza University of Rome; Viale Regina Elena 336 00161 Rome Italy
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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.
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Wille SMR, Di Fazio V, Samyn N. Drug-facilitated sexual crime by use of ketamine and diazepam by a gynaecologist. Drug Test Anal 2013; 5:730-5. [DOI: 10.1002/dta.1554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/19/2013] [Accepted: 08/22/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah M. R. Wille
- National Institute of Criminalistics and Criminology; Laboratory of Toxicology; Vilvoordsesteenweg 100; 1120; Brussels; Belgium
| | - Vincent Di Fazio
- National Institute of Criminalistics and Criminology; Laboratory of Toxicology; Vilvoordsesteenweg 100; 1120; Brussels; Belgium
| | - Nele Samyn
- National Institute of Criminalistics and Criminology; Laboratory of Toxicology; Vilvoordsesteenweg 100; 1120; Brussels; Belgium
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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.
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Affiliation(s)
- Lambert K Sørensen
- Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
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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
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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]
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Petersen IN, Tortzen C, Kristensen JL, Pedersen DS, Breindahl T. Identification of a new metabolite of GHB: gamma-hydroxybutyric acid glucuronide. J Anal Toxicol 2013; 37:291-7. [PMID: 23612681 DOI: 10.1093/jat/bkt027] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gamma-hydroxybutyric acid (GHB) is an important analyte in clinical and forensic toxicology with a narrow detection window of 3-6 h. In the search of improved detection methods, the existence in vivo of a glucuronated GHB metabolite (GHB-GLUC) was hypothesized. Chemically pure standards of GHB-GLUC and a deuterated analogue for chromatography were synthesized. Liquid chromatography and tandem mass spectrometry were used for targeted analysis in anonymous clinical urine samples (n = 50). GHB-GLUC was found in concentrations ranging from 0.11 to 5.0 µg/mL (mean: 1.3 ± 1.2 µg/mL). Thus far, this is the first report of a GHB glucuronide detected in biological samples. Given that glucuronides generally have longer half-life values than their corresponding free drugs, GHB-GLUC should theoretically be a biomarker of GHB intoxication. It is also proposed that the hitherto unexplained reports of elevated GHB concentrations in some biological samples, which has caused the setting of a relatively high cutoff value (10 µg/mL), represent total GHB measurements (sum of free GHB and actively chemically hydrolyzed GHB-GLUC). To address these challenges, the present study must be followed by comprehensive pharmacokinetic and stability studies after the controlled administration of GHB.
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Affiliation(s)
- Ida Nymann Petersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Schep LJ, Knudsen K, Slaughter RJ, Vale JA, Mégarbane B. The clinical toxicology of γ-hydroxybutyrate, γ-butyrolactone and 1,4-butanediol. Clin Toxicol (Phila) 2012; 50:458-70. [PMID: 22746383 DOI: 10.3109/15563650.2012.702218] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Gamma-hydroxybutyrate (GHB) and its precursors, gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD), are drugs of abuse which act primarily as central nervous system (CNS) depressants. In recent years, the rising recreational use of these drugs has led to an increasing burden upon health care providers. Understanding their toxicity is therefore essential for the successful management of intoxicated patients. We review the epidemiology, mechanisms of toxicity, toxicokinetics, clinical features, diagnosis, and management of poisoning due to GHB and its analogs and discuss the features and management of GHB withdrawal. METHODS OVID MEDLINE and ISI Web of Science databases were searched using the terms "GHB," "gamma-hydroxybutyrate," "gamma-hydroxybutyric acid," "4-hydroxybutanoic acid," "sodium oxybate," "gamma-butyrolactone," "GBL," "1,4-butanediol," and "1,4-BD" alone and in combination with the keywords "pharmacokinetics," "kinetics," "poisoning," "poison," "toxicity," "ingestion," "adverse effects," "overdose," and "intoxication." In addition, bibliographies of identified articles were screened for additional relevant studies including nonindexed reports. Non-peer-reviewed sources were also included: books, relevant newspaper reports, and applicable Internet resources. These searches produced 2059 nonduplicate citations of which 219 were considered relevant. EPIDEMIOLOGY There is limited information regarding statistical trends on world-wide use of GHB and its analogs. European data suggests that the use of GHB is generally low; however, there is some evidence of higher use among some sub-populations, settings, and geographical areas. In the United States of America, poison control center data have shown that enquiries regarding GHB have decreased between 2002 and 2010 suggesting a decline in use over this timeframe. MECHANISMS OF ACTION GHB is an endogenous neurotransmitter synthesized from glutamate with a high affinity for GHB-receptors, present on both on pre- and postsynaptic neurons, thereby inhibiting GABA release. In overdose, GHB acts both directly as a partial GABA(b) receptor agonist and indirectly through its metabolism to form GABA. TOXICOKINETICS GHB is rapidly absorbed by the oral route with peak blood concentrations typically occurring within 1 hour. It has a relatively small volume of distribution and is rapidly distributed across the blood-brain barrier. GHB is metabolized primarily in the liver and is eliminated rapidly with a reported 20-60 minute half-life. The majority of a dose is eliminated completely within 4-8 hours. The related chemicals, 1,4-butanediol and gamma butyrolactone, are metabolized endogenously to GHB. CLINICAL FEATURES OF POISONING: GHB produces CNS and respiratory depression of relatively short duration. Other commonly reported features include gastrointestinal upset, bradycardia, myoclonus, and hypothermia. Fatalities have been reported. MANAGEMENT OF POISONING: Supportive care is the mainstay of management with primary emphasis on respiratory and cardiovascular support. Airway protection, intubation, and/or assisted ventilation may be indicated for severe respiratory depression. Gastrointestinal decontamination is unlikely to be beneficial. Pharmacological intervention is rarely required for bradycardia; however, atropine administration may occasionally be warranted. WITHDRAWAL SYNDROME: Abstinence after chronic use may result in a withdrawal syndrome, which may persist for days in severe cases. Features include auditory and visual hallucinations, tremors, tachycardia, hypertension, sweating, anxiety, agitation, paranoia, insomnia, disorientation, confusion, and aggression/combativeness. Benzodiazepine administration appears to be the treatment of choice, with barbiturates, baclofen, or propofol as second line management options. CONCLUSIONS GHB poisoning can cause potentially life-threatening CNS and respiratory depression, requiring appropriate, symptom-directed supportive care to ensure complete recovery. Withdrawal from GHB may continue for up to 21 days and can be life-threatening, though treatment with benzodiazepines is usually effective.
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Affiliation(s)
- Leo J Schep
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
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Fjeld B, Burns ML, Karinen R, Larssen B, Smith-Kielland A, Vindenes V. Long-term stability of GHB in post-mortem samples and samples from living persons, stored at -20°C, using fluoride preservatives. Forensic Sci Int 2012; 222:47-51. [PMID: 22648054 DOI: 10.1016/j.forsciint.2012.04.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/26/2012] [Accepted: 04/30/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Reanalyses are frequently requested in forensic toxicology, and knowledge of the stability of drugs in biological samples is of major importance for the interpretation of the toxicological findings. Currently, the literature on stability of gammahydroxybutyrate (GHB) in blood samples from living subjects and in post-mortem blood is limited. The purpose of this study was to evaluate the long-term stability of GHB in both blood samples from persons suspected of drug use and post-mortem blood samples. METHODS A total of 59 reanalyses were performed in whole blood samples, 27 samples from living subjects and 32 samples taken at autopsies. The samples were stored in the freezer between 0.4 and 7.2 years at -20°C in vials containing preservatives. Analyses were performed by GC-FID, and cut-off level was 10.3 mg/L. The concentrations in 22 of the samples were below cut-off. RESULTS The mean change in concentration between initial analysis and reanalysis was -0.8% for the positive samples from living persons and -7.1% for the positive post-mortem samples. Changes ranged from -32.4% to 21.0% for samples from living and from -30.4% to 34.4% for post-mortem samples. All negative samples were still negative at the time of reanalysis. CONCLUSION Reanalysis of these forensic whole blood samples stored several years at -20°C with fluoride preservation did not exhibit changes in GHB concentrations of practical significance for the interpretation of toxicological findings.
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Affiliation(s)
- Bente Fjeld
- Norwegian Institute of Public Health, Division of Forensic Medicine and Drug Abuse Research, PO Box 4404, Nydalen, N-0403 Oslo, Norway.
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Zörntlein S, Kopp A, Becker J, Kaufmann T, Röhrich J, Urban R. In vitro production of GHB in blood and serum samples under various storage conditions. Forensic Sci Int 2012; 214:113-7. [DOI: 10.1016/j.forsciint.2011.07.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/04/2011] [Accepted: 07/17/2011] [Indexed: 11/30/2022]
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Elie MP, Baron MG, Birkett JW. Injection port silylation of γ-hydroxybutyrate and trans-hydroxycrotonic acid: conditions optimisation and characterisation of the di-tert-butyldimethylsilyl derivatives by GC-MS. Analyst 2011; 137:255-62. [PMID: 22081086 DOI: 10.1039/c1an15825b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Silylation is usually carried out on γ-hydroxybutyrate (GHB) for its analysis by Gas Chromatography/Mass Spectrometry (GCMS) and requires potentially long incubation times before injection during which the derivatisation reagent and derivatives (such as trimethyl-silyl compounds) can hydrolyse. Moreover, alternative internal standards (IS) are often useful depending on sample matrices, extraction/purification procedures, commercial availability and price. This study evaluated the possibility of silylating GHB with an injection port derivatisation procedure using N-methyl-N-[tert-butyldimethyl-silyl]trifluoroacetimide (MTBSTFA) with 1% tert-butyldimethylchlorosilane (TBCS) as the derivatisation reagent, producing di-tert-butyldimethyl-silyl derivatives as a novel means of analyzing GHB. In parallel, trans-hydroxycrotonic acid (t-HCA) was investigated as a potential IS for GHB quantification. Analyses were carried out with a temperature programmable injector and the GHB(t-BDMS)(2) and t-HCA(t-BDMS)(2) derivatives were successfully produced, characterised and derivatisation conditions optimised. t-HCA behaved very similarly to GHB through the derivatisation processes and was used as the IS for the determination of urinary endogenous GHB concentrations in human subjects where the method showed a limit of detection of 0.049 μg mL(-1), a limit of quantification of 0.162 μg mL(-1), and a limit of confirmation of 1.33 μg mL(-1), suitable for toxicological GHB concentration determination.
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Affiliation(s)
- Mathieu Pierre Elie
- School of Life Science, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK.
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Bosman IJ, Verschraagen M, Lusthof KJ. Toxicological Findings in Cases of Sexual Assault in the Netherlands*. J Forensic Sci 2011; 56:1562-8. [DOI: 10.1111/j.1556-4029.2011.01888.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ingrid J. Bosman
- Department of Pathology and Toxicology, Netherlands Forensic Institute, PO Box 24044, The Hague 2490 AA, The Netherlands
| | - Miranda Verschraagen
- Department of Pathology and Toxicology, Netherlands Forensic Institute, PO Box 24044, The Hague 2490 AA, The Netherlands
| | - Klaas J. Lusthof
- Department of Pathology and Toxicology, Netherlands Forensic Institute, PO Box 24044, The Hague 2490 AA, The Netherlands
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Wood DM, Brailsford AD, Dargan PI. Acute toxicity and withdrawal syndromes related to γ-hydroxybutyrate (GHB) and its analogues γ-butyrolactone (GBL) and 1,4-butanediol (1,4-BD). Drug Test Anal 2011; 3:417-25. [PMID: 21548140 DOI: 10.1002/dta.292] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/21/2011] [Accepted: 03/22/2011] [Indexed: 02/05/2023]
Abstract
Gamma-hydroxybutyrate (GHB) has been used as a recreational drug since the 1990s and over the last few years there has been increasing use of its analogues gamma-butyrolactone (GBL) and to a lesser extent 1,4-butanediol (1,4BD). This review will summarize the literature on the pharmacology of these compounds; the patterns and management of acute toxicity associated with their use; and the clinical patterns of presentation and management of chronic dependency associated with GHB and its analogues.
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Affiliation(s)
- David M Wood
- Guy's and St Thomas' NHS Foundation Trust, London, UK.
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LeBeau MA, Montgomery MA. Comments on “Gamma-hydroxybutyrate in urine and serum: Additional data supporting current cut-off recommendations”. Forensic Sci Int 2011; 207:e61. [DOI: 10.1016/j.forsciint.2010.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 09/26/2010] [Indexed: 10/18/2022]
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Marclay F, Saudan C, Vienne J, Tafti M, Saugy M. Source inference of exogenous gamma-hydroxybutyric acid (GHB) administered to humans by means of carbon isotopic ratio analysis: novel perspectives regarding forensic investigation and intelligence issues. Anal Bioanal Chem 2011; 400:1105-12. [DOI: 10.1007/s00216-011-4891-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/08/2011] [Accepted: 03/09/2011] [Indexed: 11/29/2022]
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Andresen H, Aydin BE, Mueller A, Iwersen-Bergmann S. An overview of gamma-hydroxybutyric acid: pharmacodynamics, pharmacokinetics, toxic effects, addiction, analytical methods, and interpretation of results. Drug Test Anal 2011; 3:560-8. [DOI: 10.1002/dta.254] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/05/2010] [Accepted: 12/06/2010] [Indexed: 11/11/2022]
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Brown SD, Melton TC. Trends in bioanalytical methods for the determination and quantification of club drugs: 2000-2010. Biomed Chromatogr 2010; 25:300-21. [DOI: 10.1002/bmc.1549] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/09/2010] [Accepted: 09/10/2010] [Indexed: 11/10/2022]
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48
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Blood GHB concentrations and results of medical examinations in 25 car drivers in Norway. Eur J Clin Pharmacol 2010; 66:987-98. [DOI: 10.1007/s00228-010-0870-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 07/09/2010] [Indexed: 11/26/2022]
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49
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Andresen H, Sprys N, Schmoldt A, Mueller A, Iwersen-Bergmann S. Gamma-Hydroxybutyrate in Urine and Serum: Additional Data Supporting Current Cut-Off Recommendations. Forensic Sci Int 2010; 200:93-9. [PMID: 20418032 DOI: 10.1016/j.forsciint.2010.03.035] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/15/2010] [Accepted: 03/20/2010] [Indexed: 11/15/2022]
Affiliation(s)
- H Andresen
- Department of Toxicology, Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany.
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Zvosec DL, Smith SW, Porrata T, Strobl AQ, Dyer JE. Case series of 226 γ-hydroxybutyrate-associated deaths: lethal toxicity and trauma. Am J Emerg Med 2010; 29:319-32. [PMID: 20825811 DOI: 10.1016/j.ajem.2009.11.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 11/05/2009] [Accepted: 11/07/2009] [Indexed: 11/29/2022] Open
Abstract
γ-Hydroxybutyrate (GHB) and its prodrugs are drugs of abuse that were also sold as "dietary supplements." Users present to emergency departments with overdose, impaired driving, withdrawal, and associated trauma. We compiled a series of GHB-associated deaths to elucidate lethal risks, GHB concentrations, cointoxicants, products, uses, and medical interventions. Death records were reviewed for toxicology, autopsy findings, and history. Inclusion cutoffs were as follows: 5/10 mg/L of GHB (antemortem blood/urine) and 50/20/7 mg/L of GHB (postmortem blood/urine/vitreous). Of 226 deaths included, 213 had cardiorespiratory arrest and 13 had fatal accidents. Seventy-eight deaths (35%) had no cointoxicants. Sixteen deaths involved "supplements" and 1 involved pharmaceutical GHB (Xyrem, Jazz Pharmaceuticals, Palo Alto, CA). Postmortem blood GHB was 18 to 4400 mg/L (median, 347 mg/L) in deaths negative for cointoxicants. Cardiorespiratory arrest occurred prehospital in 100% of 184 cases with available history. Of 72 cases with antemortem adverse effects reported, medical assistance was delayed or absent in 66; of these, acute GHB ingestion was known in 51, including 40 left to "sleep off" adverse effects. Thirty others were left "sleeping" and found dead. γ-Hydroxybutyrate is lethal even without cointoxicants, directly and through fatal accidents. Medical interventions were frequently delayed or absent despite known GHB ingestion, and witnessed adverse events and cardiorespiratory arrest occurred prehospital. Education is needed about the lethality of GHB and the necessity for prompt medical intervention.
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Affiliation(s)
- Deborah L Zvosec
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
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