Gamma-Hydroxybutyric acid (GHB) well known as Liquid Ecstasy and Liquid X is voluntarily consumed not only by partygoers: It is increasingly used to substitute more expensive drugs.

One reason is that already low doses of GHB induce strong euphoria, especially when consumed in addition to alcohol. Furthermore, GHB (k.o. drops) is administered on the sly to daze people in order to rape or rob them. Up to now, only in these cases made public in the press a GHB determination has been initiated. The estimated number of unrealized cases is much higher, probably because they are less spectacular to the media and less often obvious at first sight like the following example.

A car driver in his forties was stopped by the police because he was driving zigzag. He was extremely agitated his responsiveness was limited, so that an emergency physician had to be called. He diagnosed a cerebral seizure and had to intubate and to artificially respirate the patient. After these emergency measures, the patient was still suffering from a fluctuation delirium with predominant productive but low vegetative involvement. At first, physicians couldn’t get to the real origin of symptoms even though the patient was hospitalized for 11 days and thoroughly examinated. Previous diagnoses like Diabetes and a minor trauma following a fall made the final diagnosis difficult. In addition, a screening for common drugs, pharmaceuticals and alcohol markers including Ethylglucuronide was negative. The patient was temporarily responsive but then again delirant; the symptoms disappeared but after 4 days. The course of the delirium which showed only few signs of vegetative symptomatic was atypical for an alcoholic one. The symptoms „seizure“, coma, atypical, fluctuative delirium with low vegetative involvement led to the suspicion of GHB deprivation.

At first, the patient vehemently denied GHB consumption during the anamnestic session. The urine sample collected at the day of hospitalization was tested for GHB with the enzymatic method provided by BÜHLMANN Laboratories AG and thus GHB abuse was finally detected. After having been confronted with the result, the patient admitted GHB/GBL consumption.

Up to now GHB measurements have only been requested in case of suspected GHB abuse. Laboursome chromatographic methods are so far state of the art of GHB determination. A simple, automated method can help cope with increasing demand of GHB determinations e.g. in routine drug screening or sobriety tests.

BÜHLMANN’s enzymatic GHB test which was developed and evaluated for clinical chemistry analyzers in collaboration with Dr. A. Scholer, Basle, and Ms. Dr. H. Andresen, Forensic Medicine, Hamburg, is sensitive, easy and field-proven. The test thus passed its first practical challenge right after the product launch.