Severe intoxication from xylazine inhalation

Abstract

We present the first documented case of overdose from xylazine inhalation. The patient developed findings consistent with alpha 2 adrenergic agonist toxicity, eg coma, miosis, apnea, bradycardia, hypothermia, and dry mouth 2 hours after exposure. Standard dose naloxone did not reverse these effects. The patient fully recovered after appropriate supportive measures. A review of prior reports of xylazine exposure is provided.

Letter To The Editor: “Xylazine abuse: A rare cause of syncope”

“…In the first case, the patient was discovered in a coma with intermittent apnea and bradycardia. He recovered completely after hydration and ventilator support (6). In the second case, the patient inhaled xylazine several times.…”

“…Xylazine, like clonidine, stimulates presynaptic α 2 -adrenergic receptors resulting in a decreased release of adrenaline from nerve terminals (4,5). Neurological effects include ataxia, hypotonia, lethargy, coma, respiratory depression, and apnea (6). Cardiovascular effects include an initial hypertension with sustained hypotension and increased vagal tone-related bradyarrhythmogenic effects predominating (3).…”

“…Miosis and hyperglycemia have also been noted (6,7). Only two cases of intentional xylazine intoxication by inhalation have been reported previously (6,8). In the first case, the patient was discovered in a coma with intermittent apnea and bradycardia.…”

GC–MS confirmation of xylazine (Rompun), a veterinary sedative, in exchanged needles

“…In all, 280/370 (75.5%) syringes had speedball, a prevalence that is consistent with previous estimates in PR (Colon et al 2001;Alegria et al 2004;Finlinson et al 2006). There are a number of acute toxicology reports (Poklis and Mackell 1985;Spoerke et al 1986;Mittleman et al 1998;Capraro et al 2001;Hoffmann et al 2002;Arican et al 2004;Elejalde et al 2003) and anecdotal case descriptions of Xyz abuse (Lewis et al 1983;Haigh 1988); to our knowledge there are no reports regarding the health consequences of either chronic Xyz use or co-injecting Xyz and speedball. To determine the multiple impacts of these two factors, further studies are required, the results of which are likely to be quite different from those presented in existing literature.…”

“…Though there are reports on acute toxicity induced by Xyz injection or inhalation (Spoerke et al 1986;Mittleman et al 1998;Capraro et al 2001;Hoffmann et al 2002), and a single case report of Xyz-Ketamine abuse (Arican et al 2004), no information exists regarding the prevalence of chronic Xyz abuse and its resulting health consequences, particularly when coused with speedball.…”