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The challenge of post-mortem GHB analysis: storage conditions and specimen types are both important

  • J. Kietzerow
  • B. Otto
  • N. Wilke
  • H. Rohde
  • S. Iwersen-Bergmann
  • H. Andresen-StreichertEmail author
Original Article

Abstract

Background

For the interpretation of concentrations of gamma-hydroxybutyrate (GHB) in post-mortem specimens, a possible increase due to post-mortem generation in the body and in vitro has to be considered. The influence of different storage conditions and the specimen type was investigated.

Method and material

Post-mortem GHB concentrations in femoral venous blood (VB), heart blood (HB), serum (S) from VB, urine (U), cerebrospinal fluid (CSF) and vitreous humour (VH) were determined by gas chromatography–mass spectrometry after derivatisation. Various storage conditions, that is 4 °C or room temperature (RT) and the addition of sodium fluoride (NaF), were compared during storage up to 30 days. Additionally, bacterial colonisation was determined by mass spectrometry fingerprinting.

Results

Twenty-six cases without involvement of exogenous GHB were examined. GHB concentrations (by specimen) at day 0 were 3.9–22.1 mg/L (VB), 6.6–33.3 mg/L (HB), < 0.5–18.1 mg/L (U), 1.1–10.4 mg/L (CSF) and 1.7–22.0 mg/L (VH). At 4 °C, concentrations increased at day 30 to 5.6–74.5 mg/L (VB), 4.6–76.5 mg/L (HB) and < 0.5–21.3 mg/L (U). At RT, concentrations rose to < 0.5–38.5 mg/L (VB), 1.2–94.6 mg/L (HB) and < 0.5–37.5 mg/L (U) at day 30. In CSF, at RT, an increase up to < 0.5–21.2 mg/L was measured, and at 4 °C, a decrease occurred (< 0.5–6.5 mg/L). GHB concentrations in VH remained stable at both temperatures (1.2–20.9 mg/L and < 0.5–26.2 mg/L). The increase of GHB in HB samples with NaF was significantly lower than that without preservation. No correlation was found between the bacterial colonisation and extent of GHB concentration changes.

Conclusion

GHB concentrations can significantly increase in post-mortem HB, VB and U samples, depending on storage time, temperature and inter-individual differences. Results in CSF, VH, S and/or specimens with NaF are less affected.

Keywords

GHB Post-mortem Storage Cerebrospinal fluid Vitreous humour Liquor Serum Whole blood Bacteria 

Notes

Acknowledgements

We thank the toxicology team at the Institute of Legal Medicine in Hamburg for their encouragement.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

414_2019_2150_MOESM1_ESM.xlsx (44 kb)
ESM 1 (XLSX 44 kb)
414_2019_2150_MOESM2_ESM.docx (25 kb)
ESM 2 (DOCX 24 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Legal Medicine, Department of Forensic ToxicologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Institute of Legal Medicine, Department of Forensic Toxicology, Faculty of MedicineUniversity Hospital CologneCologneGermany
  3. 3.Department of Internal MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany
  4. 4.Institute of Forensic MedicineUniversity Medical Center Schleswig-HolsteinLübeckGermany
  5. 5.Department of Medical Microbiology, Virology and HygieneUniversity Medical Center Hamburg-EppendorfHamburgGermany

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