title: Intentional overdose of Large Animal Immobilon.
abstract: 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.
authors.affiliation: Department of Emergency, University Hospital, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Joeri
authors.initials: J
authors.lastname: Sterken
authors.forename: Joris
authors.initials: J
authors.lastname: Troubleyn
authors.forename: Frank
authors.initials: F
authors.lastname: Gasthuys
authors.forename: Viviane
authors.initials: V
authors.lastname: Maes
authors.forename: Mark
authors.initials: M
authors.lastname: Diltoer
authors.forename: Christian
authors.initials: C
authors.lastname: Verborgh
mesh_terms: D018806:APACHE; D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D003131:Combined Modality Therapy; D016638:Critical Illness; D018450:Disease Progression; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005048:Etorphine / Q000506:poisoning*; D017809:Fatal Outcome; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D008728:Methotrimeprazine / Q000506:poisoning*; D013406:Suicide, Attempted; D014218:Triage
chemical_list: D004338:Drug Combinations; C004820:Immobilon; D005048:Etorphine; D008728:Methotrimeprazine