Fatal Overdose of Gamma‐hydroxybutyrate Acid After Ingestion of 1,4‐Butanediol

Abstract

ABSTRACT:We report a case of fatal intoxication from 1,4-butanediol (1,4-BD), which was ingested by a young and "na€ ıve" gammahydroxybutyrate (GHB) consumer during a party with the co-ingestion of alcohol, cannabis, and methylene-dioxy-methamphetamine. The following drug concentrations were found using gas chromatography coupled with mass spectrometry on autopsy samples and on a cup and a glass found at the scene: 20,350 mg/L (bottle) for 1,4-BD; 1020 mg/L (femoral blood), 3380 mg/L (cardiac blood), 47,280 mg/L (gastric content), and 570 mg/L (vitreous humor) for GHB. The concentration of GHB is difficult to interpret in forensic cases due to the possibility of an endogenous production of GHB. The variable tolerance of the user may also modify the peri-and postmortem GHB concentrations. This case underscores the need to have many different sources of toxicology samples analyzed to avoid the hypothesis of endogenous production of GHB.

Quantification of GHB and GHB-GLUC in an 1,4-butanediol intoxication: A case report

“…Throughout these cases, whenever there was a full recovery after ER intervention, 1,4-BD was absent in all the blood samples. On the other hand, when death was the final outcome, 1,4-BD was found in two of the four post-mortem cases [9,10]. Concerning to GHB concentration values, it ranged from 317 mg/L to 415 mg/L in in vivo samples, and from 432 mg/L to 837 mg/L in post-mortem cases.…”

“…This may be an important reason for the lack of published references concerning intoxication by 1,4-BD. In fact, only a few cases have been found in the literature, involving outcomes from full recovery to death [9,10]. Throughout these cases, whenever there was a full recovery after ER intervention, 1,4-BD was absent in all the blood samples.…”

The use of prodrugs as drugs of abuse

“…GHB is associated with the risk of overdose, and its use has been increasing in the UK especially among sexual minority groups (Darke et al, 2020; Felmlee et al, 2021). GBL and 1,4‐BD have also been independently implicated in overdose cases (Delcourt et al, 2020; Fischer et al, 2023; Le Garff et al, 2018; Soria, 2021).…”