Xylazine toxicity

Background

• Analogue of clonidine and agonist at alpha 2 adrenergic receptor
• Veterinary sedative, anesthetic, analgesic, and muscle relaxant
• Human drug of abuse, usually as drug adulterant

Clinical Features

• Bradycardia
• Respiratory depression
• Hypotension

Differential Diagnosis

• See Bradycardia, Hypotension

Sedative/hypnotic toxicity

• Absinthe
• Barbiturates
• Benzodiazepines
  • Flunitrazepam (Rohypnol)
• Chloral hydrate
• Gamma hydroxybutyrate (GHB)
• Baclofen toxicity
• Opioids
  • Lomotil toxicity
  • Loperamide toxicity
• Toxic alcohols
  • Ethanol
  • Ethylene glycol
  • Isopropyl alcohol
  • Methanol
• Xylazine toxicity

Evaluation

• Evaluate for alternate etiologies
• Clinical diagnosis

Management

• Supportive: address airway/respiratory drive/blood pressure, atropine for bradycardia

Disposition

• Admit if not back to baseline

References

https://www.ncbi.nlm.nih.gov/pubmed/24769343