Gamma-hydroxybutyrate: bridging the clinical-analytical gap

Area of Science:

• Clinical Chemistry
• Forensic Toxicology
• Analytical Chemistry

Background:

• Gamma-hydroxybutyrate (GHB) detection methods evolved significantly since the 1960s due to increased recreational use in the 1990s.
• GHB analysis is vital in clinical toxicology for diagnosing coma in overdose patients, investigating postmortem cases, and identifying drug-facilitated sexual assaults.

Purpose of the Study:

• To review the clinical utility and analytical considerations for laboratory detection of GHB and related compounds.
• To highlight the importance of understanding analytical method sensitivity, endogenous GHB levels, and postmortem GHB generation for accurate interpretation.

Main Methods:

• Review of existing analytical methodologies for GHB detection.
• Discussion of factors influencing GHB analysis, including endogenous production, metabolism, and postmortem changes.
• Consideration of laboratory cut-off levels, instrument sensitivity, and the need to request specific GHB-related compounds.

Main Results:

• Current analytical methods for GHB are essential for various clinical and forensic scenarios.
• Laboratory cut-off levels often do not differentiate between endogenous and exogenous GHB.
• Accurate interpretation necessitates knowledge of GHB metabolism, endogenous levels, and potential postmortem generation.

Conclusions:

• Clinical interpretation of GHB levels requires a comprehensive understanding of its biochemistry and analytical limitations.
• Specific requests for GHB and related compounds are recommended due to potential analytical method limitations.
• Factors such as sample storage conditions can significantly impact GHB analysis and interpretation.