Gamma-hydroxybutyrate (GHB), 1,4-butanediol (1,4BD), and gamma-butyrolactone (GBL) intoxication: A state-of-the-art review

& gamma;-hydroxybutyrate (GHB) is synthesized endogenously from & gamma;-aminobutyric acid (GABA) or exogenously from 1,4-butanediol (butane-1,4-diol; 1,4-BD) or & gamma;-butyrolactone (GBL). GBL, and 1,4-BD are rapidly converted to GHB. The gastric absorption time, volume of distribution, and half-life of GHB are between 5 and 45 min, 0.49 & PLUSMN; 0.9 L/kg, and between 20 and 60 min, respectively. GHB and its analogues have a dose-dependent effect on the activation of GHB receptor, GABA-B, and GABA localized to the central nervous system. After ingestion, most patients present transient neurological disorders (lethal dose: 60 mg/kg). Chronic GHB consumption is associated with disorders of use and a withdrawal syndrome when the consumption is discontinued. GHB, GBL, and 1,4-BD are classified as narcotics but only the use of GHB is controlled internationally. They are used for drug facilitated (sexual) assault, recreational purposes, slamsex, and chemsex. To confirm an exogenous intake or administration of GHB, GBL, or 1-4-BD, the pre-analytical conservation is crucial. The antemortem cutoff doses for detection are 5 and 5-15 mg/L, with detection windows of 6 and 10 h in the blood and urine, respectively Control of GHB is essential to limit the number of users, abuse, associated risks, and death related to their consumption.

Automated summary

γ-Hydroxybutyrate (GHB) is synthesized from γ-aminobutyric acid (GABA) or 1,4-butanediol (1,4-BD) or γ-butyrolactone (GBL). GBL and 1,4-BD are rapidly converted to GHB. GHB and its analogues affect GABA receptors in the central nervous system. Ingestion of GHB can cause transient neurological disorders. Chronic use is associated with withdrawal syndrome. GHB is controlled internationally, while GBL and 1,4-BD are not. They are used for drug facilitated assault, recreation, and chemsex. Proper conservation is crucial for detection of GHB, GBL, and 1,4-BD. Control of GHB is important to limit consumption-related risks and death.