RESUMEN
We describe a case of voluntary self-injection with Large Animal Immobilon, a veterinary anaesthesia product containing etorphine, a very strong opioid, and acepromazine, a phenothiazine. This resulted in cardiorespiratory arrest and the need for sustained haemodynamic support after resuscitation. Large Animal Immobilon is used under specific conditions only, mainly in zoo and wildlife medicine. Primary toxicological analysis, although guided by the presumed toxin, could only detect a metabolite of acepromazine in the urine. Further analysis was able to show some traces of etorphine. A number of topics are treated, including the apparent potency of the etorphine and the selection of a suitable antidote, taking into account the different properties of the respective agents.
Asunto(s)
Etorfina/envenenamiento , Paro Cardíaco/inducido químicamente , Paro Cardíaco/terapia , Metotrimeprazina/envenenamiento , APACHE , Adulto , Reanimación Cardiopulmonar/métodos , Terapia Combinada , Enfermedad Crítica , Progresión de la Enfermedad , Combinación de Medicamentos , Quimioterapia Combinada , Resultado Fatal , Femenino , Escala de Coma de Glasgow , Humanos , Intento de Suicidio , TriajeRESUMEN
High-performance liquid chromatography-diode-array detection results obtained during the investigation of two cases involving acepromazine prompted us to study the stability of the drug in blood. It was found that acepromazine can undergo in vitro conversion by human red blood cells to 2-(1-hydroxyethyl)promazine, a product that has been reported as a minor urinary metabolite in horse urine but not previously identified in humans. Further, our analytical findings in the two cases examined suggest that 2-(1-hydroxyethyl)promazine may be the major unconjugated metabolite of acepromazine in humans. These findings have important implications for the analytical toxicology of acepromazine.
Asunto(s)
Acepromazina/sangre , Antipsicóticos/sangre , Promazina/análogos & derivados , Acepromazina/análogos & derivados , Acepromazina/química , Antipsicóticos/química , Cromatografía Líquida de Alta Presión , Combinación de Medicamentos , Estabilidad de Medicamentos , Etorfina/metabolismo , Etorfina/envenenamiento , Medicina Legal/métodos , Homicidio , Humanos , Metotrimeprazina/metabolismo , Metotrimeprazina/envenenamiento , Promazina/sangre , Promazina/química , Intento de SuicidioRESUMEN
Etorphine is a synthetic narcotic analgesic usually used in veterinary medicine. It possesses an analgesic potency up to 1000 times greater than morphine and is therefore used in low doses, primarily for tranquilising large animals. For veterinary use, etorphine is usually available in its commercial formulation as Immobilon, when in combination with acepromazine or methotrimeprazine. Due to the potency of etorphine, only very low doses are required to produce adverse or fatal effects. This paper describes a method for detecting and quantifying etorphine using HPLC with UV diode array detection (HPLC-DAD) and demonstrates the advantage of the technique for the detection of Immobilon at low doses. In a forensic case involving Immobilon, the etorphine concentrations measured in postmortem femoral vein and heart blood specimens were 14.5 and 23.5 micrograms/l, respectively. No etorphine was detected in the urine. To our knowledge this is the first time postmortem etorphine concentrations have been reported.