Fatal Overdose of Gamma-hydroxybutyrate Acid After Ingestion of 1,4-Butanediol.
We report a case of fatal intoxication from 1,4-butanediol (1,4-BD), which was ingested by a young and naïve gamma-hydroxybutyrate (GHB) consumer during a party with the co-ingestion of alcohol, cannabis, and methylene-dioxy-methamphetamine. The following drug concentrations were found using gas chromatography coupled with mass spectrometry on autopsy samples and on a cup and a glass found at the scene 20,350 mgL (bottle) for 1,4-BD 1020 mgL (femoral blood), 3380 mgL (cardiac blood), 47,280 mgL (gastric content), and 570 mgL (vitreous humor) for GHB. The concentration of GHB is difficult to interpret in forensic cases due to the possibility of an endogenous production of GHB. The variable tolerance of the user may also modify the peri- and postmortem GHB concentrations. This case underscores the need to have many different sources of toxicology samples analyzed to avoid the hypothesis of endogenous production of GHB.