GHB-involved crimes among intoxicated patients

Kapitány-Fövény, Máté; Zacher, Gábor; Posta, József; Demetrovics, Zsolt

doi:10.1016/j.forsciint.2017.02.028

Cited by 20 publications

(6 citation statements)

References 41 publications

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“…People become dizzy and drowsy, they experience nausea and vomiting, and often become unconscious and require emergency hospital treatment [10]. Furthermore, people intoxicated by GHB suffer from anterograde amnesia, which is one of the reasons this drug is used by perpetrators in sexual assault cases [15][16][17][18][19]. The difference between a recreational dose of GHB and a toxic or lethal dose is fairly narrow, which probably accounts for many accidental overdose deaths involving this drug [20][21][22].…”

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confidence: 99%

Interpreting γ-hydroxybutyrate concentrations for clinical and forensic purposes

Busardò

Jones

2018

Clinical Toxicology

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Introduction: c-Hydroxybutyric acid is an endogenous substance, a therapeutic agent, and a recreational drug of abuse. This psychoactive substance acts as a depressant of the central nervous system and is commonly encountered in clinical and forensic practice, including impaired drivers, poisoned patients, and drug-related intoxication deaths. Objective: The aim of this review is to assist clinical and forensic practitioners with the interpretation of c-hydroxybutyric acid concentrations in blood, urine, and alternative biological specimens from living and deceased persons. Methods: The information sources used to prepare this review were PubMed, Scopus, and Web-of-Science. These databases were searched using keywords c-hydroxybutyrate (GHB), blood, urine, alternative specimens, non-conventional biological matrices, saliva, oral fluid, sweat, hair, vitreous humor (VH), brain, cerebrospinal fluid (CSF), dried blood spots (DBS), breast milk, and various combinations thereof. The resulting 4228 references were screened to exclude duplicates, which left 1980 articles for further consideration. These publications were carefully evaluated by taking into account the main aims of the review and 143 scientific papers were considered relevant. Analytical methods: The analytical methods used to determine c-hydroxybutyric acid in blood and other biological specimens make use of gas-or liquid-chromatography coupled to mass spectrometry. These hyphenated techniques are accurate, precise, and specific for their intended purposes and the lower limit of quantitation in blood and other specimens is 0.5 mg/L or less. Human pharmacokinetics: GHB is rapidly absorbed from the gut and distributes into the total body water compartment. Only a small fraction of the dose (1-2%) is excreted unchanged in the urine. The plasma elimination half-life of c-hydroxybutyric acid is short, being only about 0.5-0.9 h, which requires timely sampling of blood and other biological specimens for clinical and forensic analysis. Endogenous concentrations of GHB in blood: GHB is both an endogenous metabolite and a drug of abuse, which complicates interpretation of the laboratory results of analysis. Moreover, the concentrations of GHB in blood and other specimens tend to increase after sampling, especially in autopsy cases. This requires the use of practical "cut-off" concentrations to avoid reporting false positive results. These cutoffs are different for different biological specimen types. Concentrations of GHB in clinical and forensic practice: As a recreational drug GHB is predominantly used by young males (94%) with a mean age of 27.1 years. The mean (median) and range of concentrations in blood from apprehended drivers was 90 mg/L (82 mg/L) and 8-600 mg/L, respectively. The concentration distributions in blood taken from living and deceased persons overlapped, although the mean (median) and range of concentrations were higher in intoxication deaths; 640 mg/ L (280 mg/L) and 30-9200 mg/L, respectively. Analysis of GHB in alternative specimens: All bi...

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Interpreting γ-hydroxybutyrate concentrations for clinical and forensic purposes

Busardò

Jones

2018

Clinical Toxicology

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“…Moreover, GHB is known to be subject to postmortem formation. A number of review articles on the pharmacology and toxicology of GHB including aspects like interpretation of GHB in a forensic setting have been published in the last years (Andresen, Aydin, Mueller, & Iwersen-Bergmann, 2011;Andresen-Streichert et al, 2015;Busardo & Jones, 2015;Busardo, Kyriakou, Napoletano, Marinelli, & Zaami, 2015;Busardo, Zaami, Baglio, Indorato, Montana, Giarratana, et al, 2015;Castro et al, 2014;Kapitany-Foveny, Zacher, Posta, & Demetrovics, 2017). One of the most important aspects in this respect is the differentiation of GHB endogenously present or formed postmortem from intentionally ingested or surreptitiously administered GHB, for example, by a spiked drink.…”

Section: Influences By Postmortem (Microbial) Formation Of Toxicologically Relevant Compoundsmentioning

confidence: 99%

Antemortem and postmortem influences on drug concentrations and metabolite patterns in postmortem specimens

Peters

Steuer

2018

WIREs Forensic Science

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When interpreting postmortem analytical data, toxicologists must be aware that postmortem concentrations of xenobiotics and/or their metabolites may be influenced by many factors. Some of these influences occur antemortem like the general pharmacokinetic properties of the xenobiotic or individual pharmacokinetics in the particular subject. They determine the concentrations at the time of death and may be relevant for the determination of the manner rather than the cause of death. Other influences occurring postmortem include continuing drug metabolism, chemical, and/or microbial degradation as well as potential postmortem formation of some toxicologically relevant compounds. Such postmortem effects may tremendously change the concentrations of xenobiotics and/or their metabolites at the time of death. If not adequately considered, this may lead to false conclusions regarding the involvement of the respective xenobiotic in the cause of death. The present article will provide an overview on antemortem and postmortem effects giving examples from the literature. It will also discuss if and how such effects may be identified based on postmortem specimens and, in case of the postmortem effects, how they may be reduced by proper storage and addition of stabilizers like fluoride salts. This article is categorized under: Toxicology > Post‐Mortem Toxicology Toxicology > Analytical Toxicology Toxicology > Drug Stability

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“…However, ingestion of 20-30 mg/kg of GHB can lead to dizziness, drowsiness, nausea, and vomiting, while intake of GHB over 50 mg/kg can lead to coma and death [16,17]. Moreover, people intoxicated with GHB may suffer from anterograde amnesia, which is one of the reasons criminals use this drug in sexual assault cases [18]. Possible withdrawal symptoms post GHB use include mild tremor, tachycardia, high blood pressure, anxiety, agitation, seizures, insomnia, severe disorientation, hallucinations, delirium, and rhabdomyolysis [19].…”

Section: Introductionmentioning

confidence: 99%

Metabolic Alterations Associated with γ-Hydroxybutyric Acid and the Potential of Metabolites as Biomarkers of Its Exposure

et al. 2021

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γ-Hydroxybutyric acid (GHB) is an endogenous short chain fatty acid that acts as a neurotransmitter and neuromodulator in the mammalian brain. It has often been illegally abused or misused due to its strong anesthetic effect, particularly in drug-facilitated crimes worldwide. However, proving its ingestion is not straightforward because of the difficulty in distinguishing between endogenous and exogenous GHB, as well as its rapid metabolism. Metabolomics and metabolism studies have recently been used to identify potential biomarkers of GHB exposure. This mini-review provides an overview of GHB-associated metabolic alterations and explores the potential of metabolites for application as biomarkers of GHB exposure. For this, we discuss the biosynthesis and metabolism of GHB, analytical issues of GHB in biological samples, alterations in metabolic pathways, and changes in the levels of GHB conjugates in biological samples from animal and human studies. Metabolic alterations in organic acids, amino acids, and polyamines in urine enable discrimination between GHB-ingested animals or humans and controls. The potential of GHB conjugates has been investigated in a variety of clinical settings. Despite the recent growth in the application of metabolomics and metabolism studies associated with GHB exposure, it remains challenging to distinguish between endogenous and exogenous GHB. This review highlights the significance of further metabolomics and metabolism studies for the discovery of practical peripheral biomarkers of GHB exposure.

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GHB-involved crimes among intoxicated patients

Cited by 20 publications

References 41 publications

Interpreting γ-hydroxybutyrate concentrations for clinical and forensic purposes

Interpreting γ-hydroxybutyrate concentrations for clinical and forensic purposes

Antemortem and postmortem influences on drug concentrations and metabolite patterns in postmortem specimens

Metabolic Alterations Associated with γ-Hydroxybutyric Acid and the Potential of Metabolites as Biomarkers of Its Exposure

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