Fatal intoxication with 1,4‐butanediol: Case report and comprehensive review of the literature

Abstract

AbstractA fatal case of 1,4‐butanediol (1,4‐BD) oral ingestion is reported here, in which a 51‐year‐old man was found dead in his bed. According to the police report, the deceased was a known drug user. A glass bottle labeled (and later confirmed to be) “Butandiol 1,4” (1,4‐BD) was found in the kitchen. Furthermore, the deceased's friend stated that he consumed 1,4‐BD on a regular basis. The autopsy and histological examination of postmortem parenchymatous organ specimens did not revealed a clear cause of death. Chemical‐toxicological investigations revealed gammahydroxybutyrat (GHB) in body fluids and tissues in the following quantities: femoral blood 390 mg/L, heart blood 420 mg/L, cerebrospinal fluid 420 mg/L, vitreous humor 640 mg/L, urine 1600 mg/L, and head hair 26.7 ng/mg. In addition, 1,4‐BD was qualitatively detected in the head hair, urine, stomach contents, and the bottle. No other substances, including alcohol, were detected at pharmacologically relevant concentrations. 1,4‐BD is known as precursor substance that is converted in vivo into GHB. In the synoptic assessment of toxicological findings, the police investigations and having excluded other causes of death, a lethal GHB‐intoxication following ingestion of 1,4‐BD, can be assumed in this case. Fatal intoxications with 1,4‐BD have seldom been reported due to a very rapid conversion to GHB and, among other things, non‐specific symptoms after ingestion. This case report aims to give an overview to the published of fatal 1,4‐BD‐intoxications and to discuss the problems associated with detection of 1,4‐BD in (postmortem) specimens.