Hoffman Robert S, Kirrane Barbara M, Marcus Steven M
New York City Poison Center, New York University School of Medicine, New York, NY, USA.
Ann Emerg Med. 2008 Nov;52(5):548-53. doi: 10.1016/j.annemergmed.2008.04.026. Epub 2008 May 23.
Illicit drugs may be adulterated with substances other than the sought-after substance of abuse. Although the true incidence and clinical effects of this practice are unknown, geographically disparate outbreaks of clinically significant adulteration continue to occur. We report on a recent outbreak of clenbuterol-adulterated heroin occurring along the East Coast of the United States.
After identification of index cases, 5 US poison centers collaborated with state and territorial health departments to alert the public of clenbuterol-tainted heroin. A case definition of clenbuterol-tainted heroin toxicity was promulgated, and emergency departments (EDs) were asked to contact poison centers when cases were identified.
We identified 34 probable or confirmed ED presentations in 5 states during a 6-month period. Thirteen of the 34 patients met the criteria for "confirmed" exposures. Clenbuterol was identified in the blood and or urine of 12 of these 13 patients. Clenbuterol concentrations ranged from 2.4 to 26 ng/mL in the blood and 9.4 to 12,526 ng/mL in the urine. Symptoms included nausea, chest pain, palpitations, dyspnea, and tremor. Physical findings included significant tachycardia, hypotension, and laboratory evidence of hyperglycemia, hypokalemia, and increased lactate levels. Six patients demonstrated biochemical evidence of myocardial injury. Ten patients received beta-adrenergic antagonists without adverse effect.
The adulteration of heroin by clenbuterol was associated with sympathomimetic effects, metabolic acidosis, and myocardial injury. The report also highlights how collaborative efforts among poison centers using the Centers for Disease Control and Prevention's Epi-X system rapidly identified a disease outbreak.
非法药物可能会被掺入除了所寻求的滥用物质之外的其他物质。尽管这种做法的真实发生率和临床影响尚不清楚，但临床上具有显著掺假情况的不同地区的疫情仍在不断发生。我们报告了近期在美国东海岸发生的一起掺有克伦特罗的海洛因疫情。
在确定首例病例后，5个美国毒物中心与州和地区卫生部门合作，向公众发出含有克伦特罗的海洛因的警报。发布了克伦特罗污染海洛因毒性的病例定义，并要求急诊科在发现病例时联系毒物中心。
在6个月的时间里，我们在5个州确定了34例可能或确诊的急诊科就诊病例。34名患者中有13名符合“确诊”暴露标准。在这13名患者中的12名患者的血液和/或尿液中检测到了克伦特罗。血液中克伦特罗浓度范围为2.4至26纳克/毫升，尿液中为9.4至12526纳克/毫升。症状包括恶心、胸痛、心悸、呼吸困难和震颤。体格检查发现包括明显的心动过速、低血压以及高血糖、低钾血症和乳酸水平升高的实验室证据。6名患者有心肌损伤的生化证据。10名患者接受了β-肾上腺素能拮抗剂治疗，无不良反应。
克伦特罗掺入海洛因与拟交感神经作用、代谢性酸中毒和心肌损伤有关。该报告还强调了毒物中心利用疾病控制和预防中心的Epi-X系统开展的合作努力如何迅速识别疾病疫情。
