Unusually high concentrations in a fatal GHB case

Area of Science:

• Forensic Toxicology
• Analytical Chemistry

Background:

• Gamma-hydroxybutyrate (GHB) is a central nervous system depressant with a high potential for abuse.
• Fatal overdoses involving GHB have been documented globally, necessitating reliable analytical methods for its detection and quantification in postmortem investigations.

Observation:

• The first documented fatal GHB overdose case in France is presented.
• Comprehensive toxicological analysis was performed on various biological specimens including blood, bile, urine, vitreous humor, gastric contents, and pubic hair.
• Gas chromatography-mass spectrometry (GC-MS) and GC-MS-MS techniques were employed for GHB detection and quantification.

Findings:

• Extremely high concentrations of GHB were detected in femoral blood (2937 mg/L), urine (33,727 mg/L), bile (1800 mg/L), and vitreous humor (2856 mg/L), with the blood concentration being the highest reported.
• Pubic hair analysis indicated chronic GHB abuse, with concentrations significantly exceeding physiological levels.
• Evidence suggested an oral route of ingestion, with 7.08 g of GHB found in gastric contents.
• Co-ingestion of Methylenedioxymethamphetamine (MDMA) was identified in femoral blood.

Implications:

• This case highlights the critical importance of comprehensive toxicological screening for GHB in fatal overdose investigations.
• The findings underscore the potential for GHB to cause fatal outcomes, even with co-ingestion of other substances.
• The analytical methods validated in this study provide a robust framework for future forensic investigations involving GHB.