Gamma-hydroxybutyrate poisoning: clinical diagnosis versus laboratory findings.

The clinical diagnosis of gamma-hydroxybutyrate (GHB) poisoning can be challenging due to the heterogeneous nature of its manifestations and the frequent co-consumption of other psychoactive substances. A recent study aimed to investigate the accuracy of clinical diagnosis of GHB poisoning compared to laboratory findings in blood samples. The study included 87 patients aged 16 years and above who were admitted to the hospital with a suspected diagnosis of GHB poisoning. The diagnosis was made by the treating doctor based on clinical information, patient history, and information from companions. Blood samples were taken at admission and analyzed using ultra high-performance liquid chromatography-tandem mass spectrometry to confirm the presence of GHB. The study found that GHB was detected in the blood samples of 60 (69.0%) patients, with a median age of 35 years and 58.6% being male. The patients who tested positive for GHB had a significantly lower Glasgow Coma Scale (GCS) score, with a median score of 6, indicating a decreased level of consciousness. The GCS score was inversely correlated with GHB concentrations, suggesting that higher levels of GHB were associated with more severe impairment of consciousness. Nearly half of the patients who tested positive for GHB required treatment in an intensive care unit, and 5% needed endotracheal intubation. The study also found that co-consumption of other psychoactive substances, such as amfetamines, cocaine, and benzodiazepines, was common among patients who tested positive for GHB. This highlights the complexity of diagnosing GHB poisoning, as the presence of other substances can mask or modify the clinical presentation of GHB toxicity. The study's findings suggest that clinicians may overdiagnose GHB poisoning, as only two out of three patients with suspected GHB poisoning actually tested positive for the substance. This emphasizes the importance of laboratory confirmation to ensure accurate diagnosis and treatment of GHB poisoning. Link: https://pubmed.ncbi.nlm.nih.gov/40272047/