Service de Pharmacologie-Toxicologie et Pharmacovigilance, CHU Angers, Angers, France; Université d'Angers, Angers, France.
Service de Pharmacologie-Toxicologie et Pharmacovigilance, CHU Angers, Angers, France; Université d'Angers, Angers, France; Laboratoire MitoVasc, UMR INSERM 1083 CNRS 6015, Angers, France.
Forensic Sci Int. 2022 Jul;336:111324. doi: 10.1016/j.forsciint.2022.111324. Epub 2022 Apr 30.
During the last decade, only few cases of acute etizolam intoxication have been detailed. Little is known about the toxic effects of etizolam overdose. Here, the authors report the case of a 42-year-old man who was admitted to the emergency department for intense agitation following etizolam and cocaine consumption. Detection and determination of etizolam and cocaine (including metabolites) were achieved using liquid chromatography tandem mass spectrometry. Etizolam and benzoylecgonine (BZE) were detected in plasma at 64 and 10 ng/mL, respectively. The level of cocaine was below the limit of quantification (< 5 ng/mL). To the authors' knowledge, the only report detailing an etizolam overdose was provided by O'Connell et al. and was characterized by the presence of central nervous system (CNS) depression signs. Interestingly, here, there were no signs of CNS depression but only signs of CNS excitation. With regard to cocaine and BZE plasma concentrations, the clinical presentation cannot be only explained by the co-consumption of cocaine. It may be hypothesized that the clinical presentation was related to a paradoxical reaction to etizolam overdose. To date, no case of paradoxical excitation related to etizolam use has been reported in adults. The case presented here appears particularly interesting, given the limited data relating to high-dose etizolam toxicity.
在过去的十年中，仅有少数几例急性依替唑仑中毒的详细情况被描述。关于依替唑仑过量的毒性作用知之甚少。在这里，作者报告了一例 42 岁男性的病例，该患者在依替唑仑和可卡因吸食后因强烈激动而被送往急诊部。使用液相色谱串联质谱法检测和确定依替唑仑和可卡因（包括代谢物）。在血浆中检测到依替唑仑和苯甲酰爱康宁（BZE）的浓度分别为 64 和 10ng/mL。可卡因的浓度低于定量下限（<5ng/mL）。据作者所知，唯一详细描述依替唑仑过量的报告是由 O'Connell 等人提供的，其特征是存在中枢神经系统（CNS）抑制迹象。有趣的是，在这里，没有 CNS 抑制的迹象，只有 CNS 兴奋的迹象。关于可卡因和 BZE 血浆浓度，临床表现不能仅用可卡因的共同消费来解释。可以假设临床表现与依替唑仑过量的矛盾反应有关。迄今为止，在成人中尚未报告与依替唑仑使用相关的矛盾兴奋的病例。鉴于与高剂量依替唑仑毒性相关的数据有限，这里报告的病例尤其有趣。
