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Clinical Chemistry 44: 692, 1998;
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(Clinical Chemistry. 1998;44:692.)
© 1998 American Association for Clinical Chemistry, Inc.

Letters

{gamma}-Hydroxybutyrate Concentrations in Pre- and Postmortem Blood and Urine

Erin L. Fieler, Daniel E. Coleman, and Randall C. Baselta

Chem. Toxicol. Institute, 1167 Chess Dr., Suite E, Foster City, CA 94404
a Author for correspondence.


To the Editor:

With {gamma}-hydroxybutyrate (GHB) becoming popular as a drug of abuse in the US and elsewhere (1), we are receiving increasing requests for the analytical determination of GHB in blood or urine in criminal investigations, especially in sexual assault cases. In a recent report of a fatal poisoning with GHB, the victim had a postmortem blood GHB concentration of 27 mg/L (2), and another three GHB-related fatalities were reported with postmortem blood GHB concentrations of 52–121 mg/L (3).

As a part of a validation study before instituting a GC-MS method described by others (4), we tested for GHB presence in a series of forensic specimens submitted routinely to us by law enforcement agencies and medical examiner offices in cases not known to be GHB-related. No GHB was detected (detection limit, 1 mg/L) in the blood or urine of living persons or in postmortem urine, but very substantial concentrations, ranging from 3.2 to 168 mg/L, were found in 15 of 20 autopsy blood specimens (Table 1 ). Reanalysis of these 20 blood specimens by gas chromatography with flame-ionization detection on a packed column (5) gave similar qualitative and quantitative results.


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  		Table 1. GHB concentrations in blood (n = 20) and urine (n = 8) by GC-MS.

These results have great potential significance to the interpretation of postmortem blood GHB concentrations, because the concentration range of this apparent "endogenous" GHB overlaps that known to produce clinical effects in patients receiving the drug as an anesthetic agent (6) as well as the concentrations reported to be associated with fatal reactions in medicolegal investigations (2)(3). The fact that substantial GHB concentrations are found in the blood of deceased persons but not in living persons suggests that GHB is a product of postmortem decomposition.

We are unable to state from our data whether factors such as environmental temperature or storage time contribute to an increase in postmortem blood GHB concentrations. However, we suggest that analysis of GHB in urine, in which the concentrations tend to parallel those in blood but are ~10-fold greater (6), would produce more meaningful results in the investigation of drug-related death.


References

  1. . Centers for Disease Control. Multistate outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. JAMA 1991;265:447-448.[Free Full Text]
  2. Mozayani A, Brown T, Carter J. The tip of the iceberg in the Harris County Forensic Center. Presentation at Am Acad Forensic Sci annual meeting, New York, NY, February 20 1997;.
  3. Woodward W, Todd E. Gamma-hydroxybutyrate. Presentation at Southwestern Assoc Toxicol semiannual meeting, San Antonio, TX, April 5 1997;.
  4. Ferrara SD, Tedeschi L, Frison G, et al. Therapeutic gamma-hydroxybutyric acid monitoring in plasma and urine by gas chromatography– mass spectrometry. J Pharm Biomed Anal 1993;11:483-487.[Web of Science][Medline] [Order article via Infotrieve]
  5. van der Pol W, van der Kleijn E, Lauw M. Gas-chromatographic determination and pharmacokinetics of 4-hydroxybutyrate in dog and mouse. J Pharmacokinet Biopharm 1995;3:99-113.
  6. Baselt RC, Cravey RH. Disposition of toxic drugs and chemicals in man, 4th ed 1995:348-349 Chemical Toxicology Institute Foster City, CA. .



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This Article
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