A sudden awakening from a near coma after combined intake of gamma-hydroxybutyric acid (GHB) and ethanol

Objective: A case of a sudden awakening from a near coma after combined intake of gamma-hydroxybutyric acid (GHB) (125 mu g/mL), ethanol (134 mg/dL), and cannabinoids is described. Methods: GHB was determined by gas chromatography-mass spectrometry after acetonitrile precipitation and derivation with N-methyl-N-trimethylsilyltrifluoroacetamide using valproic acid as the internal standard. Conclusion: The described case illustrates the consequences of GHB overdose, GHB overdose should be considered in every case of unexplained sudden coma, i.e., without any evidence of head injury, intake of coma-inducing drugs, or increasing intracranial pressure, GHB overdose will be missed by routine toxicological screening.