Gamma-hydroxybutyric acid (GHB) is present in blood and urine of the general population as an endogenous compound. The published concentrations in postmortem blood ranged from 0-168 mg/L in cases with no previous history of GHB use. Interpretation of GHB results should be carefully considered due to the wide distribution of endogenous concentrations. The objectives of this study are to evaluate and verify the accuracy of a proposed published (50 mg/L) cut-off in 120 blood and 64 urine samples in postmortem cases selected randomly, and to identify GHB-related fatalities. GHB was determined by gas chromatography– mass spectrometry (GC–MS) after extraction of the blood and urine in the presence of the internal standard GHB-D6.
The GHB concentration in majority of the blood samples (95%) was ≤ 50 mg/L, while in 81% it ranged from 10-50 mg/L. In 95% of the urine samples, the GHB concentration ranged from 10-20 mg/L while 82% of the samples had a concentration of < 10 mg/L. In cases where GHB intoxication was identified, GHB concentrations ranged from 264 to >500 mg/L. The proposed published GHB concentration of 50 mg/L may be used as a cut-off to distinguish between natural endogenous concentrations and exogenous use, but this is not sufficient by itself. The detected GHB concentrations, both in vivo and in postmortem samples, require careful interpretation, not only due to its endogenous nature, but also due to the possibility of postmortem production and also due to its rapid metabolism and excretion.In order to distinguish the endogenous GHB concentration from those reflecting abusive GHB levels, defining a specific cut-off value in biological samples is very crucial. Other matrices, such as vitreous humour, femoral blood and hair must also be considered when interpreting postmortem GHB concentrations.