Xylazine Poisoning in Clinical and Forensic Practice: Analysis Method, Characteristics, Mechanism and Future Challenges
Abstract
:1. Introduction
2. Xylazine, Structures and Pharmacokinetics
2.1. Xylazine, Structures and Usage
2.2. Pharmacokinetics
3. Analytic Aspects
4. Clinical and Forensic Aspect of Xylazine Poisoning
4.1. Characteristics of Xylazine Poisoning
4.2. Characteristics in Xylazine-Related Death Cases
4.3. Mechanism of Xylazine-Related Death
4.4. Blood and Urine
Xylazine Concentrations
4.5. Alternative Samples
4.6. Other Drugs or Toxins in Such Cases
5. Future Challenges
6. Conclusions
Funding
Data Availability Statement
Conflicts of Interest
References
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Analysis | Matrix (mL) | Sample Preparation | Sample | LODa ng/mL | Linear Range ng/mL | Author, Publication Year | |
---|---|---|---|---|---|---|---|
Xylazine | LC-MS/MS | 1.0 2.0 g | Liquid—liquid extraction | Blood, urine, beef, venison | Blood 2.5, urine, 2.5, Meat 2.5 µg/kg | 1.0~300.0 | Yao et al. 2023, [29] |
LC-MS/MS | 1.0 | Liquid—liquid extraction | Blood | 0.02 | 0.1~200 | Xu et al. 2023, [28] | |
LC-MS/MS | 0.5 | Liquid—liquid extraction | Serum, Urine | Serum, 1, Urine 1 | Blood 10~750, Urine 10~750 | Krongvorakul et al. 2018, [8] | |
SPE-HPLC/MS/MS | 1.0 | SPE | Blood, Urine | Blood 0.4, Urine 0.3 | Blood 2~2000, Urine 2~2000 | Liu et al. 2017, [30] | |
UPLC-QTOF/MS | 1.0 | Liquid—liquid extraction | Blood, Urine | Blood 0.4, Urine 0.3 | Blood 2~2000, Urine 2~2000 | Gao et al. 2015, [31] | |
DMA | SPE-HPLC/MS/MS | 1.0 | SPE | Blood, Urine | Blood 0.4, Urine 0.3 | Blood 2~2000, Urine 2~2000 | Liu et al. 2017, [30] |
UPLC-QTOF/MS | 1.0 | Liquid—liquid extraction | Blood, Urine | Blood 0.5, Urine 0.3 | Blood 10~4000, Urine 10~4000 | Gao et al. 2015, [31] |
Authors and Publication Year | Age/Sex | Cause | Exposure Route | Primary Symptoms | Time Interval between Oral and Symptom | Drug Concentration |
---|---|---|---|---|---|---|
Yao et al. 2023, [29] | Unknown, 5 victims | Accident | Oral | Drowsiness, hypokalemia | 15–40 min Mean 25 min | Blood 4.8–11.3 ng/mL, Urine 6.7–218.1 ng/mL, Cooked beef 440.0 µg/kg |
Unknown, 5 victims | Accident | Oral | Dry mouth, dizziness, drowsiness | 30–60 min Mean 45 min | Blood 8.6–46.8 ng/mL, Venison 193.0 µg/kg Cooked venison 5.0 mg/kg | |
Xu et al. 2023, [28] | Unknown, 12 victims | Homicide | Oral | Dizzy | Unknown | 9.6~139.5 |
Gill EL et al. 2023, [34] | 8/M | Unknown | Unknown | loss of consciousness, hypopneic with pinpoint pupils, headache | Unknown | Xylazine and fentanyl positive |
Krongvorakul et al. 2018, [8] | 73/F | homicide | Oral | Coma, bradycardia | Unknown | Gastric content, positive. Serum, negative |
71/F | homicide | Oral | Coma, bradycardia | Unknown | Urine, 0.294 μg/mL Serum, 0.0057 μg/mL | |
76/M | homicide | Oral | Coma, bradycardia | Unknown | Urine, 0.533 μg/mL | |
Liu et al. 2017, [30] | unknown | Accident | Oral | Unknown | Unknown | Peripheral blood xylazine and 2,6-Dimethylaniline positive |
Forrester MB. 2016, [35] | 76 victims, 41M, 33F, mean age 37 | 49 unintentional, 24 were intentional, 1 misuse; 1 adverse reaction, 1 unknown | 39 injection, 21 ingestion, 12 dermal route, 11 ocular route, 2 inhalation, and 2 unknown, 9 multiple. | Drowsiness/lethargy [36], Bradycardia [15], Hypotension [8], Hypertension [7] Puncture/wound [6], Slurred speech [6], Coma [5], Ocular irritation/pain [5], Respiratory depression [4] | Unknown | Positive |
Wang et al. 2014, [36] | Unknown, 1 male, 4 females | Suicide | Oral | Unknown | Unknown | 200–1000 mg, one death |
Hou et al. 2013, [37] | Unknown, more than 50 victims | Accident | Oral | Unknown | Unknown | Peripheral blood, cooked meat xylazine positive |
Meyer et al. 2013 [38] | 14/M | Accident | Injection | Coma, bradycardia | Unknown | Plasma 0.3 mg/L of xylazine and 0.1 mg/L of ketamine |
Zhang et al. 2010, [39] | 31/M | Accident | Inhaled | Dyspnea | Unknown | Unknown |
Liu et al. 2007, [40] | 19/M | Accident | Oral | Coma, 35.5 °C, bradycardia | Unknown | Urine 582 mg/L of ketamine, 448 mg/L of norketamine, 745 mg/L of phenobarbital, and 762 mg/L of xylazine |
Velez et al. 2006, [13] | 38/M | Accident | Unintentional irrigation of both eyes | Bradycardia, hypotension to 90/60 mm Hg, consciousness impairment, | 2 h | Unknown |
Xia et al. 2006, [41] | 7 victims, 1 male, 6 females, 28–48 years old | homicide | Oral | Dizziness, drowsiness, palpitations, impaired consciousness | 0.5–2 h | Heart blood 12.86 μg/mL |
Elejalde et al.2003, [42] | 18/M | Suicide | inhaled | Blood pressure 90/60 mmHg, heart rate 45 bpm, disorientation, dysarthria, dysmetria, ataxia, sinus bradycardia | Unknown | urine for common toxins was negative |
Capraro et al. 2001, [15] | 16/M | Suicide | inhaled | Coma, bradycardia | Unknown | Blood 0.54 μg/mL perhaps 3 mg of dose |
Samanta et al. 1990, [43] | 19/M | Accident | Injection | 80/60 mm Hg, small pupils | 30 min | Unknown |
Authors and Publication Year | Age/Sex | Cause | Exposure Route | Primary Symptoms | Time Interval between Oral and Symptom | Time Interval between Oral and Death | Autopsy and Pathology Findings | Postmortem Sampled Time | Postmortem Drug Concentration ng/mL |
---|---|---|---|---|---|---|---|---|---|
Rock et al. 2023, [10] | 43/F | Suicide | Injection | Unknown | Unknown | Unknown | Recent puncture wounds to the groin | Unknown | Blood 38 Urine 135 |
Zhang et al. 2021, [44] | 49/F | Homicide | Injection | Dizzy | 30 min | Less than 10.5 h | Bleeding point is seen in the conjunctiva, bleeding was observed on the injection site of right thigh | Unknown | Heart blood 2.4 Injection site positive |
Moore et al. 2003, [45] | 42/M | Suicide | injection | Unknown | Unknown | Unknown | Unknown | Unknown | Heart blood 2300 ng/mL, peripheral blood 2900, Bile 6300, Kidney 7.8 mg/kg, Liver 6.1 mg/kg, Urine 10 |
Poklis et al. 1985, [12] | 36/M | Suicide | Injection | Unknown | Unknown | Within 4 h | Injection sites on antecubital fossa, congested edematous lung | Unknown | Blood 200, Brain 0.4 mg/kg, Kidney 0.6 mg/kg, Liver 0.9 mg/kg, Lung 1.1 mg/kg, Adipose 0.05 mg/kg, Urine 7000 |
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Mai, T.; Zhang, Y.; Zhao, S. Xylazine Poisoning in Clinical and Forensic Practice: Analysis Method, Characteristics, Mechanism and Future Challenges. Toxics 2023, 11, 1012. https://doi.org/10.3390/toxics11121012
Mai T, Zhang Y, Zhao S. Xylazine Poisoning in Clinical and Forensic Practice: Analysis Method, Characteristics, Mechanism and Future Challenges. Toxics. 2023; 11(12):1012. https://doi.org/10.3390/toxics11121012
Chicago/Turabian StyleMai, Tingting, Youyou Zhang, and Shuquan Zhao. 2023. "Xylazine Poisoning in Clinical and Forensic Practice: Analysis Method, Characteristics, Mechanism and Future Challenges" Toxics 11, no. 12: 1012. https://doi.org/10.3390/toxics11121012