Choon Lee Kee, Khiruddin Ain Izzati, Annuar Wan Masliza Wan Mohd, Shamsuddin Sazwan Reezal
Department of Emergency and Trauma, Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia.
Turk J Emerg Med. 2023 Jan 2;23(2):119-122. doi: 10.4103/tjem.tjem_198_22. eCollection 2023 Apr-Jun.
Xylazine is a type of sedative commonly used in veterinary medicine. It acts on the central alpha-2 receptor and suppresses norepinephrine release from the peripheral nerve terminal. It is also reported to have action on cholinergic, serotogenic, H2-histamine, dopaminergic, and opioid receptors. Once administered in animals, it causes hypotension, bradycardia, central nervous system depression, and respiratory depression. The effect will start within minutes after absorption and last up to 4 h depending on the dosage given. Till date, it is only exclusively used in animals as approved by the Food and Drug Administration. Human intoxication is uncommon, and no specific antidote is available. Naloxone, a competitive opioid receptor antagonist, was postulated to have an antidotal effect on xylazine. We report two cases of accidental human injection with xylazine. Naloxone was administered in one of the cases. Acute hypertension and mydriasis were observed; however, no apparent reversal of toxidrome was seen. This finding reveals the question regarding the efficacy and benefit of naloxone usage in xylazine intoxication. General management remains supportive of care focusing on ventilation and hemodynamics. Attending physicians should be aware of potential xylazine intoxication incidents in the area of livestock or veterinary activities.
赛拉嗪是一种常用于兽医学的镇静剂。它作用于中枢α-2受体，抑制去甲肾上腺素从外周神经末梢释放。据报道，它还对胆碱能、5-羟色胺能、H2-组胺、多巴胺能和阿片受体有作用。一旦给动物使用，它会导致低血压、心动过缓、中枢神经系统抑制和呼吸抑制。吸收后几分钟内开始起效，根据给药剂量，作用可持续长达4小时。迄今为止，它仅在获得美国食品药品监督管理局批准的情况下专门用于动物。人类中毒情况并不常见，且没有特效解毒剂。纳洛酮是一种竞争性阿片受体拮抗剂，据推测对赛拉嗪有解毒作用。我们报告了两例意外注射赛拉嗪的人类病例。其中一例使用了纳洛酮。观察到急性高血压和瞳孔散大；然而，未见到明显的中毒症状逆转。这一发现揭示了关于纳洛酮用于赛拉嗪中毒的疗效和益处的问题。一般治疗仍以支持性护理为主，重点关注通气和血流动力学。主治医生应注意在牲畜或兽医活动区域可能发生的赛拉嗪中毒事件。
