Case Study: Two Fatal Case Reports of Acute Yohimbine Intoxication
Case Study: Two Fatal Case Reports of Acute Yohimbine Intoxication
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DOI：
10.1093/jat/bkt057
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发表时间：
2013-10-01
影响因子：
2.5
通讯作者：
Wade, Norman
中科院分区：
文献类型：
--
作者：
Anderson, Colin;Anderson, Dan;Wade, Norman
育亨宾是一种生物碱，在街上被用作壮阳药、致幻剂、膳食补充剂和勃起功能障碍药物。盐酸育亨宾是一种α 2肾上腺素受体拮抗剂，阻断突触前和突触后α 2肾上腺素受体，导致去甲肾上腺素和多巴胺释放增加。5-15 mg的平均口服剂量产生40-400 ng/mL的治疗性全血水平范围。在血液浓度高达5，000 ng/mL的情况下观察到导致神经毒性作用的过量。来自马拉西亚县医学检验所和洛杉矶县验尸官部门的实验室都遇到了一个案例，在这个案例中，通过液-液碱性药物提取并在GC-MS上检测，在全血中鉴定出育亨宾。由于这两个机构都不存在有效的育亨宾定量方法，所以这两个机构都将血液标本转交给NMS Labs，Inc.。参考实验室采用LC-MS-MS分析血液样本，并确定育亨宾的定量值为7，400和5，400 ng/mL。鉴于没有其他显著的阳性结果，以及所述的育亨宾血液浓度很高，各法医确定死因是急性育亨宾中毒，死亡方式是事故。育亨宾是一种很少遇到的药物在法医个案工作，并解释的结果是很难评估的原因和方式的死亡没有这样的案例研究被描述。
Yohimbine is an alkaloid that has been encountered on the streets as an aphrodisiac, hallucinogen, dietary supplement and erectile dysfunction drug. Yohimbine hydrochloride is an alpha 2-adrenoreceptor antagonist, blocking the pre- and postsynaptic alpha-2 adrenoreceptors and causing an increased release of noradrenaline and dopamine. An average oral dose of 5-15 mg produces a therapeutic whole blood level range of 40-400 ng/mL. Overdoses leading to neurotoxic effects have been seen with blood concentrations up to 5,000 ng/mL. The laboratories from the Maricopa County Medical Examiner and the Los Angeles County Department of Coroner each encountered a case in which yohimbine was identified in whole blood by means of a liquid-liquid basic drug extraction with detection on a GC-MS. Because validated quantitative methods for yohimbine did not exist at either facility, both agencies referred the blood specimens to NMS Labs, Inc. The reference laboratory analyzed the blood specimens with an LC-MS-MS and determined the quantitative values of yohimbine to be 7,400 and 5,400 ng/mL. Given the absence of other significant positive findings and the substantial yohimbine blood concentrations cited, the respective Medical Examiners determined the cause of death to be acute yohimbine intoxication with the mode being an accident. Yohimbine is a rarely encountered drug in medical examiner casework, and interpretation of the results is difficult to assess toward the cause and manner of death without such case studies being described.