engleski

Gamma-hydroxybutiric acid (GHB) intoxication - a case report

Gamma-hydroxybutiric acid (GHB) has become a common drug of abuse worldwide. Hereby we report, according to our knowledge, the first case of GHB intoxication in Croatia. A 33-year old man was admitted to the Emergency Department (ED) due to unknown intoxication. The patient was found in an aggressive state with hallucinations. Shortly upon arriving to the ED, he experienced a cardiopulmonary arrest and was transferred to the Intensive Care Unit. Among other laboratory tests, drug screening was performed (Syva RapidTest d.a.u. 10 ; Siemens). Confirmation analysis were performed using gas chromatography-mass spectrometry (GCMS- QP2010 Ultra ; Shimadzu) after acetonitrile precipitation and BSTFA/1% derivatization. Laboratory investigation on the day of admission revealed high and rapidly increasing creatine kinase, creatinine and CRP, respiratory acidosis and hyperglycemia. Urinalysis showed gross hematuria. Patient’s blood and urine ethanol levels were 0.00 g/L. Urine toxicology screen was positive for benzodiazepines, cannabinoides and amphetamines which was confirmed by a GCMS method after a conventional sample preparation using liquid- liquid extraction. The presence of GHB was confirmed only after acetonitrile precipitation and BSTFA silylation. Throughout the period of hospitalization the patient experienced delirium, cognitive disturbances, severe agitation and muscle spasms and did not respond to benzodiazepines therapy. The presented case illustrates the severe consequences of GHB intoxication. Psychotropic effects may be explained by GHB transformation into the inhibitory neurotransmitter gamma- aminobutyric acid (GABA). Supportive care is the key to management. Since GHB analysis is omitted by routine toxicological procedures, its intoxication is difficult to diagnose and may lead to life-threating complications.

Gamma-hydroxybutiric acid, intoxication

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