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A multi-drug intoxication fatality involving Xyrem (GHB)
Brianne E Akins1, Estuardo Miranda, J Matthew Lacy
1Washington State Patrol, Forensic Laboratory Services Bureau, 2203 Airport Way S., Suite 360, Seattle, WA 98134, USA.
Journal of Forensic Sciences
|February 4, 2009
Summary
Accidental death resulted from prescribed Gamma-hydroxybutyrate (GHB) and other CNS depressants. The patient
Area of Science:
- Forensic Toxicology
- Clinical Pharmacology
Background:
- Gamma-hydroxybutyrate (GHB) is known for recreational use and as a therapeutic agent (Xyrem) for narcolepsy.
- The case involves a patient prescribed Xyrem for narcolepsy alongside other central nervous system (CNS) depressants.
Observation:
- A 53-year-old female patient undergoing Xyrem treatment died while on multiple CNS depressant medications.
- Toxicological analysis detected significant blood (165.6 mg/L) and urine (90.7 mg/L) concentrations of GHB.
- The patient had a history of sleep apnea and snoring, which are contraindications for GHB use.
Findings:
- The blood GHB concentration was within a range associated with induced sleep.
- Combined use of prescribed CNS depressants, including GHB, exacerbated by sleep apnea and snoring, led to the fatal outcome.
- The manner of death was officially classified as accidental.
Implications:
- Highlights the critical importance of considering patient comorbidities like sleep apnea when prescribing GHB.
- Underscores the potential risks associated with polypharmacy involving CNS depressants.
- Emphasizes the need for careful monitoring and risk assessment in patients treated with GHB for narcolepsy.
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