Intoxication of a Young Girl Reveals the Pitfalls of GHB Rapid Screening

Abstract

The authors discuss the case of a 14-year-old girl who was transferred to the ICU of our hospital with ethanol intoxication (3.3 g/L), loss of consciousness (E5M3V1), and severe amnesia on recovery that was suspected of gamma-hydroxybutyric acid (GHB) intoxication. STAT toxicology screening may be necessary, when sexual assault under GHB intoxication is suspected. Therefore, the initial analysis of a urine sample was performed with a new enzymatic assay analysis for GHB. The enzymatic assay reported a GHB concentration of 26 mg/L, which is above the cut-off value of 10 mg/L. This cut-off value is to differentiate endogenous and exogenous levels because low levels of GHB occur naturally in the body. However, confirmation of these results by gas chromatography, which is common practice to confirm a positive GHB, gave a negative result. This discrepancy is probably contributed to interference of ethanol with the assay. This is a substantial downside of the GHB rapid screening, since the combination of GHB and ethanol is common. It is therefore advised to confirm that the positive GHB results are lower than 50 mg/L by gas chromatography, when using the rapid screening. This way the false-positive results and consequent inappropriate social and legal actions may be avoided.

Current Biochemical Monitoring and Risk Management of Immunosuppressive Therapy after Transplantation

“…During the biochemical monitoring of patients on immunosuppressive therapy, three types of biomarkers are discussed: those associated with the risk of rejection (alloreactivity/tolerance) and those reflecting individual response to an immunosuppressive protocol (2, 7, 17). Modern risk management of immunosuppressive therapy includes the pharmacokinetic and pharmacoeconomic approach, with biomarkers as an important prediction factor.…”

“…Effective immunosuppression must provide an adequate safety profile and favorable treatment outcomes. In everyday clinical practice, however, a relatively high proportion of patients on immunosuppressive treatment may experience under-immunosuppression or over-immunosuppression (2, 3). Nowadays, a tertiary or quaternary protocol has a better risk benefit ratio due to lower individual doses of each immunosuppressant.…”