Case report: Another death associated to γ-hydroxybutyric acid intoxication

•Fatal γ-hydroxybutyric acid intoxication of a forty-year old man.•Hair analysis suggests frequent abuse of GHB or GHB precursors.•Assumption of initial GBL addition to the consumed beverage.•Lethal GHB intoxication is supported by high body tissue & fluid GHB concentrations. We report a fatal γ-hydroxybutyric acid (GHB) intoxication of a forty-year old man. According to an acquaintances’ statement, the deceased had drunk a beverage containing GHB approximately five hours before he was found. Postmortem GHB concentrations were determined using gas chromatography coupled to single quadrupole mass spectrometry after simple protein precipitation with methanol and derivatization with BSTFA (1% TMCS). Concentrations in body fluids and tissues of the deceased were as follows: cardiac blood 384 mg/L, femoral blood 358 mg/L, urine 864 mg/L, brain tissue 211 mg/kg, liver tissue 201 mg/kg, kidney tissue 492 mg/kg, bile 334 mg/L and gastric content 2025 mg/L. In an exhibit (liquid in a plastic bottle found next to the decedent) analyzed 29 days after the intake 27.6 g/L GHB were found with an increasing content during storage depending on the pH of the liquid (17 months after the intake: 70.0 g/L GHB and 121.2 g/L after adjusting the exhibit to a pH of 10 before extraction). GHB concentrations in head hair of the deceased (overall length approx. 4 cm, measured in segments of 0.5 cm) were measured using liquid chromatography coupled to triple quadrupole mass spectrometry. Concentrations in unwashed and washed hair samples were 91.9–174 ng/mg and 49.2–134 ng/mg, respectively. All cut-off values for postmortem matrices generally used for the identification of an exogenous GHB intake, which are further discussed within this publication, were exceeded. A lethal GHB intoxication can be assumed by a combination of toxicological findings, police investigations and exclusion of other causes of death.