Fatal gamma-hydroxybutyrate intoxication: a forensic case report

Background: Gamma-hydroxybutyrate (GHB), a central nervous system depressant, is a commonly used drug that is clinically and forensically significant, as it has a rapid onset and a narrow margin between recreational and fatal doses. Case presentation: A 34-year-old man was discovered dead at his residence. Several empty blister packs of medications and three partially empty bottles were found at the scene. His suicide note stated that he had ingested GHB and alprazolam. He had a history of previous suicide attempts and psychiatric illness for which he was under treatment. Autopsy revealed mild cerebral oedema, significantly congested and oedematous lungs, and general organ congestion; no gross or histological pathology was noted. Peripheral blood analysis revealed a lethal GHB concentration of 396,455 ng/mL. Additional substances detected included citalopram, desmethylcitalopram, trazodone, and desalkylflurazepam, all at non-toxic levels. Ethanol was absent. Discussion: This case emphasizes the forensic difficulties in interpreting GHB-related deaths, associated with the drug’s endogenous synthesis, rapid clearance, and postmortem production. Non-lethal benzodiazepine levels detected were unlikely to have played a role in the fatal outcome. To establish acute GHB intoxication as the cause of death, it was essential to integrate scene findings, medical history, autopsy, and toxicology results, adding valuable data to the limited literature on fatal GHB cases. Conclusion: Fatal GHB intoxication highlights the need for thorough forensic knowledge of this potent and readily available CNS depressant.