Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Neurological features of acute poisoning in paediatric patients presenting to the emergency department: a retrospective study.","authors":"Marco Roversi, Marco Marano, Francesca Cautilli, Giacomo Garone, Sebastian Cristaldi, Mara Pisani, Alessandra Salvatori, Umberto Raucci, Corrado Cecchetti, Alberto Spalice, Massimiliano Raponi, Alberto Villani","doi":"10.1080/15563650.2025.2513631","DOIUrl":"10.1080/15563650.2025.2513631","url":null,"abstract":"<p><strong>Introduction: </strong>Early recognition of paediatric poisoning is crucial for timely intervention in emergency settings. This study aims to assess the epidemiological and clinical profiles of paediatric patients presenting with neurological features due to acute poisoning.</p><p><strong>Methods: </strong>Data from children less than 18 years of age admitted to the emergency department of a tertiary paediatric hospital in Rome between 2017 and 2023 were retrospectively reviewed. Clinical variables associated with admission were reported and analysed across the entire study sample and stratified by age group. Logistic regression models were built to assess the association between clinical and/or laboratory signs and hospitalization in the whole study sample and stratified by age.</p><p><strong>Results: </strong>A total of 276 children developed neurological features and were included in the study. The median age was 15.6 years (IQR: 14.0-16.7 years), with most patients being female. Ethanol was the single most frequently ingested xenobiotic (39.5%). The most commonly observed neurological feature was altered consciousness (74.3%). Most patients (56.9%) were graded as minor neurologically on the International Programme on Chemical Safety/European Association of Poison Centres and Clinical Toxicologists Poisoning Severity Score. Patients more than 10 years of age were significantly (<i>P</i> = 0.017) more frequently females (62.6%) and were significantly (<i>P</i> = 0.001) more likely to have a psychiatric co-morbidity (41.0%) than patients less than 10 years of age (4.1%). In patients more than 10 years of age, 55% of patients ingested a xenobiotic for recreational reasons, whereas none did in those less than 10 years of age (<i>P</i> = 0.001). The main predictor of hospitalization in patients more than 10 years of age was suicidal intent (odds ratio: 10.17; <i>P</i> = 0.001).</p><p><strong>Discussion: </strong>While no specific neurological feature predicted hospitalization, ingestion of lithium, antipsychotics, and benzodiazepines increased the likelihood of admission. Female adolescents had higher rates of intentional poisoning, often linked to suicidal intent.</p><p><strong>Conclusions: </strong>Altered consciousness is the most common neurological feature in paediatric poisoning but is not directly linked to hospitalisation. While neurological symptoms are important in assessment, factors such as suicidal intent, mode of emergency access, and age are stronger predictors of hospitalization and should be prioritized in the initial evaluation.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"534-544"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between reported dose and outcome in amlodipine exposures: a 25-year retrospective poison center review.","authors":"Colleen P Cowdery, Courtney Temple","doi":"10.1080/15563650.2025.2539300","DOIUrl":"https://doi.org/10.1080/15563650.2025.2539300","url":null,"abstract":"<p><strong>Introduction: </strong>Amlodipine, a dihydropyridine calcium channel blocker, is a growing cause of poisoning fatalities in the United States. As it takes several hours following ingestion for amlodipine peak plasma concentrations to be reached, the severity of poisoning may not be immediately apparent to clinicians. This study aimed to stratify reported amlodipine exposure doses with the severity of clinical outcomes.</p><p><strong>Methods: </strong>We reviewed 25 years of Oregon Poison Center records to identify amlodipine exposures that included reported ingestion doses, did not involve other cardioactive co-ingestions and were treated with vasoactive/inotropic agents. We examined the relationship between the reported amlodipine dose, the maximum number of simultaneous vasoactive/inotropic infusions used during treatment, the use of veno-arterial extracorporeal membrane oxygenation, and clinical outcome.</p><p><strong>Results: </strong>Forty-one cases met the inclusion criteria. Reported ingestions of ≤250 mg (<i>n</i> = 20) rarely required more than two vasoactive/inotropic infusions; only one patient required veno-arterial extracorporeal membrane oxygenation, and no deaths occurred. For patients who reportedly ingested 401-1,000 mg (<i>n</i> = 14), 12 (86%) received four or more vasoactive/inotropic infusions, six (43%) received veno-arterial extracorporeal membrane oxygenation, and four (29%) died. Seven patients reportedly ingested 701-1,000 mg; all received four or more vasoactive/inotropic infusions, and four (57%) received veno-arterial extracorporeal membrane oxygenation and survived. Of the three who did not receive extracorporeal membrane oxygenation, two died, and one survived but required ongoing hemodialysis.</p><p><strong>Discussion: </strong>Amlodipine toxicity can result in profound vasoplegic shock refractory to standard therapy. Reported ingestion dose was associated with vasopressor requirements, utilization of veno-arterial extracorporeal membrane oxygenation, and mortality.</p><p><strong>Conclusion: </strong>Although limited by sample size, these findings suggest that reported amlodipine ingestions of 400 mg or greater are at high risk for refractory shock and may benefit from early transfer to a medical center capable of advanced interventions such as veno-arterial extracorporeal membrane oxygenation. Reported ingestion dose may serve as a useful early risk stratification tool for clinicians.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":"63 8","pages":"556-561"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/15563650.2025.2521962","DOIUrl":"10.1080/15563650.2025.2521962","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"606"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low risk of adverse events associated with flumazenil administration: a retrospective poison center analysis of acutely poisoned patients.","authors":"Varun Vohra, Aria Darling, Robert Welch, Sydney Daviskiba, Andrew Marshall King","doi":"10.1080/15563650.2025.2516130","DOIUrl":"10.1080/15563650.2025.2516130","url":null,"abstract":"<p><strong>Introduction: </strong>Benzodiazepine overdose can lead rarely to life-threatening central nervous system and respiratory depression. Flumazenil is a benzodiazepine antagonist. However, reported adverse effects, including seizures and cardiac dysrhythmias, has led some experts to recommend its use only in select populations. Recent studies, however, report low rates of adverse effects. Our objective was to determine the updated incidence of response and adverse effects following flumazenil with or without naloxone.</p><p><strong>Methods: </strong>We performed a retrospective review of cases involving flumazenil administration reported to a state poison center between January 1, 2012 and December 31, 2022. The primary outcome was the incidence of adverse effects secondary to flumazenil. Secondary outcomes were associated risk factors, including pro-convulsant co-exposure. We characterized outcomes in cases of naloxone co-administration. The difference in age between groups was compared using the t-test and categorical data was analyzed using Fisher's Exact test. A 2 × 2 table was constructed and 95% confidence intervals for seizures.</p><p><strong>Results: </strong>Two-hundred eighty-six cases involved flumazenil administration. Dosing information was available for 115/286 (40.2%). Chronic benzodiazepine or non-benzodiazepine sedative-hypnotic use was reported in 161/286 (56.3%). Adverse effects occurred in 23/115 patients (20%) with reported dosing information, the most common being agitation in 16/115 (13.9%). Seizures occurred in three patients (2.6%), all of whom had pro-convulsant co-exposure (<i>P</i> = 0.0128). Most patients with adverse events were chronic benzodiazepine users, 15/161 (9.3%). Naloxone co-administration occurred in 140/286 patients (49.0%) and 64/140 patients (45.7%) who received naloxone had improved mentation. Two deaths (0.7%), not attributable to flumazenil, were reported.</p><p><strong>Discussion: </strong>Low rates of adverse drug events occurred after flumazenil administration. The occurrence of seizures, regardless of pro-convulsant exposure, was low. Chronic benzodiazepine use was not associated with seizures. This may support the utility of flumazenil in precluding costly diagnostic evaluation and invasive therapeutic interventions.</p><p><strong>Conclusion: </strong>This study suggests a low rate of adverse events following flumazenil administration in patients with suspected benzodiazepine overdose with or without naloxone.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"593-602"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizures associated with single substance exposures in pediatric patients: a 15-year retrospective study.","authors":"Chia Ming Chang, Christopher P Holstege, Conner T McDonald, Sandra H Nixon, Rita Farah","doi":"10.1080/15563650.2025.2519321","DOIUrl":"10.1080/15563650.2025.2519321","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate the trends, demographics, outcomes, and substances associated with single-substance exposures associated with in seizures in pediatric patients over 15 years.</p><p><strong>Methods: </strong>This retrospective study of the National Poison Data System^® was conducted from 2009 to 2023, including pediatric patients (<20 years) who experienced seizures as a clinical effect associated with single-substance exposures. Cases with single seizures, multi/discrete seizures, or status epilepticus were included. Trends in annual frequency, seizure rates (per 100,000 exposures), and substances associated with seizures were examined.</p><p><strong>Results: </strong>Thirty thousand nine hundred and eighty-five patients with single-substance exposures associated with seizures were identified, including 1,712 cases of status epilepticus. Reports to poison centers saw an increase in cases with seizures from 1,418 in 2009 to 2,749 in 2023. The seizure rate increased from 88 to 237 per 100,000 exposures. Patients aged 13-19 years accounted for the majority of cases (66.9%), followed by aged 0-5 years (24.0%) and 6-12 years (9.1%). Diphenhydramine and bupropion were the leading contributors, with diphenhydramine-related seizures increasing from 85 in 2009 to 404 in 2023 and bupropion cases rising from 162 in 2013 to 431 in 2023. Moderate and major effects were reported in 41.9% and 35.8% of cases, respectively, with nearly half (47.8%) requiring admission to critical care units.</p><p><strong>Discussion: </strong>The current study shows an increase in substance-related pediatric seizures, particularly among adolescents and females. The significant need for critical care in nearly half of these cases shows the severity and potential long-term impact of these exposures.</p><p><strong>Conclusions: </strong>Pediatric seizures associated with single-substance exposures are on the rise, driven primarily by diphenhydramine and bupropion. This trend highlights the need for targeted prevention strategies to reduce the burden of toxic exposures and safeguard the well-being of pediatric populations.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"562-569"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased recreational ketamine use and subsequent outbreak of urological complications in The Netherlands.","authors":"Antoinette J H P van Riel, Wouter M H van der Sanden, Laetitia M O de Kort","doi":"10.1080/15563650.2025.2513622","DOIUrl":"10.1080/15563650.2025.2513622","url":null,"abstract":"<p><strong>Introduction: </strong>Recreational ketamine use has increased in the last decades with incidental reports of urological complications. This study aimed to explore trends in the number of acute intoxications and urological complications from recreational ketamine use in the Netherlands.</p><p><strong>Methods: </strong>We retrospectively studied data from 2018 to 2024 from inquiries on ketamine toxicity to the Dutch Poisons Information Centre and data from the first outpatient clinic dedicated to ketamine-induced uropathy in the Netherlands at Jeroen Bosch Hospital, 's-Hertogenbosch.</p><p><strong>Results: </strong>An increase was observed in the number of intoxications with ketamine reported to the poisons centre (from 33 in 2018 to 139 in 2024), in 12 cases (2.4%) urological complaints were reported. The number of patients with ketamine-induced uropathy treated by the outpatient clinic increased from zero in 2018 to 137 in 2024. Long-term and extensive ketamine use (>1 g/day for a median of 35 months, with a median amount of 18 g/week) was associated with urological complaints. Ketamine users in our study were predominantly males in their twenties. Co-exposures were common, 65.1% of acutely intoxicated patients and 72.1% of patients with uropathy reported using other drugs, including alcohol, in addition to ketamine. Fifty-one outpatients developed severe uropathy requiring surgery, ultimately leading to cystectomy and urinary deviation in three cases.</p><p><strong>Discussion: </strong>This study combines data from a poisons information centre and a dedicated urological ketamine outpatient clinic and describes a large cohort of patients with ketamine-induced uropathy. The extent of complications from chronic recreational ketamine use in the Netherlands only became clear from the data of the urological outpatient clinic at Jeroen Bosch Hospital, 's-Hertogenbosch.</p><p><strong>Conclusion: </strong>Ketamine-induced uropathy is rising in the Netherlands. Cooperation between poisons centres and medical specialities can enhance toxicovigilance. Increased awareness among potential users and health care providers is pivotal to prevent this from developing into a public health crisis.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"545-549"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methanol poisoning outbreak in a northwestern Moroccan town: report of 22 cases treated with hemodialysis.","authors":"Amal Zniber, Selim Benhadda, Narjis Badrane, Meryem Ennafiri, Hanane Chaoui, Mohammed Yassir Tahri, Khalid Ouhman, Zainab Kaouiri, Ali Kettani, Houda Sefiani, Loubna Benamar, Tarik Bouattar, Naima Ouzeddoun","doi":"10.1080/15563650.2025.2525410","DOIUrl":"https://doi.org/10.1080/15563650.2025.2525410","url":null,"abstract":"<p><strong>Introduction: </strong>Methanol poisoning, a serious healthcare problem in resource-poor countries, is usually caused by unintentional ingestion. Early diagnosis and optimal treatment are crucial to prevent morbidity and mortality.</p><p><strong>Methods: </strong>We report our experience with hemodialysis in patients with methanol poisoning from consumption of adulterated alcoholic beverages.</p><p><strong>Results: </strong>Of 202 patients admitted to provincial and regional hospitals with methanol poisoning, the overall mortality rate was 5%. A total of 22 patients underwent hemodialysis, none of whom died. Most were male (86.4%), with a median [IQR] age of 32 years [22-39 years]. Patients typically presented with inebriation, vomiting, blurred vision, and/or decreased visual acuity. The median [IQR] bicarbonate concentration was 10 mmol/L [8.3-19.6 mmol/L] and the median [IQR] arterial pH was 7.1 [6.9-7.13]. Methanol blood concentrations ranged from 40-1,830 mg/L before hemodialysis. Nineteen patients made a full recovery, but permanent blindness developed in three. Blood methanol concentrations were significantly higher in patients with permanent blindness (<i>P</i> = 0.02).</p><p><strong>Discussion: </strong>The optimal treatment of patients with methanol poisoning requires early recognition and initiation of effective therapy. Fomepizole is a safe and preferred antidote but is costly and currently unavailable in Morocco. We opted for oral ethanol therapy in combination with hemodialysis. Oral ethanol was well tolerated, and no adverse effects were observed.</p><p><strong>Conclusion: </strong>Despite the severity of the methanol poisoning cases received in our department, no fatalities were recorded. We believe that the implementation of a standardized clinical protocol issued by health authorities, timely initiation of hemodialysis, and the use of oral ethanol contributed to good patient outcomes.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-7"},"PeriodicalIF":3.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two analytically confirmed cases of vegetable-induced methemoglobinemia.","authors":"Margaux Gaschignard, Anna Manfredi, Marion Grimaud, Sandra Sinno-Tellier, Hervé Laborde-Casterot, Mehdi Oualha, Pascal Houze, Dominique Vodovar","doi":"10.1080/15563650.2025.2524612","DOIUrl":"https://doi.org/10.1080/15563650.2025.2524612","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characterisation of the novel benzodiazepine bromazolam-data from the ASSIST (A Surveillance Study of Illicit Substance Toxicity) study.","authors":"Lisa C Dunlop, Vicki Craik, Nicole Jarvie, Simon Hudson, Matthew Walters, James W Dear, David J Lowe","doi":"10.1080/15563650.2025.2524078","DOIUrl":"https://doi.org/10.1080/15563650.2025.2524078","url":null,"abstract":"<p><strong>Introduction: </strong>Scotland has a drug death crisis. In 2023, 58% of drug-related deaths involved benzodiazepines. Novel benzodiazepines, predominantly bromazolam, are found in the drug \"street valium\", commonly used in Scotland. This study describes features of analytically confirmed bromazolam use.</p><p><strong>Methods: </strong>This observational study was conducted at the Queen Elizabeth University Hospital, Glasgow between 17 August 2022 and 16 February 2024. The study used data from a larger surveillance study (A Surveillance Study of Illicit Substance Toxicity, clinicaltrials.gov, NCT05329142). Emergency department attendances with moderate to severe illicit substance toxicity and positive detection of bromazolam were included. Toxicological analysis was performed on anonymised samples in the Laboratory of the Government Chemist Assure laboratory using ultra performance liquid chromatography interfaced with Thermofisher Q-Exactive Orbitrap high resolution accurate mass systems. The study has full ethical approval (West of Scotland Research Ethics Committee 22/WS/0047).</p><p><strong>Results: </strong>Of 1,188 adult attendances with illicit drug toxicity, 653 qualified for toxicological analysis. Two-hundred ninety-nine (45.8%) of these involved bromazolam with increasing rates seen within this study from 22.7% in quarter 1 to 58.3% in quarter 6. The median age was 42 years (IQR: 34-50 years) and 214 (71.6%) were male. The median number of illicit substances detected in samples with bromazolam was seven (IQR: five to nine). The most common clinical feature was reduced consciousness (238 patients, 79.6%) and 37 patients (12.4%) required critical care admission.</p><p><strong>Discussion: </strong>Rates of bromazolam detection increased within the population studied, aligning with Scottish drug death figures. Though clinical features presented in this study cannot be fully attributed to bromazolam alone due to high substance co-use, reduced consciousness was frequent.</p><p><strong>Conclusion: </strong>High rates of substance co-use inhibit our ability to fully understand specific features of bromazolam toxicity, however, this study highlights its prevalence in this population and identifies clinical features in positive detections.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-11"},"PeriodicalIF":3.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xylazine detection in urine of fentanyl-positive patients from a single academic center.","authors":"Andrea Leal Lopez, Kenichi Tamama","doi":"10.1080/15563650.2025.2529016","DOIUrl":"https://doi.org/10.1080/15563650.2025.2529016","url":null,"abstract":"<p><strong>Introduction: </strong>Xylazine has increasingly been used as an additive in illicit drugs, leading to severe health consequences. The current study aims to define the total xylazine-positive cases since 2010 and to analyze the trends and clinical implications of xylazine-positive cases at the University of Pittsburgh Medical Center from 2020 to 2024.</p><p><strong>Methods: </strong>This cross-sectional academic laboratory-based study analyzed the mass spectrometry dataset, including the normalized peak sizes of xylazine and fentanyl in xylazine-positive urine comprehensive drug screening cases, along with their clinical information. The laboratory information system was also queried to obtain the total number of xylazine detections in urine comprehensive drug screening since 2010.</p><p><strong>Results: </strong>A total of 351 xylazine-positive adult cases in urine comprehensive drug screening were examined to identify trends in urine xylazine and fentanyl relative concentrations between 1 April 2020 and 31 March 2024. After excluding outpatient cases, the urine xylazine and fentanyl relative concentrations were also correlated with clinical features for the remaining 249 cases. Xylazine-positive cases have increased since 2016, with a sharp rise between 2019 and 2021. Urine xylazine relative concentrations showed a minimal decline, while urine fentanyl relative concentrations modestly decreased. Patients with skin wounds and infections, but not with coma or post-cardiac arrest, had significantly higher urine xylazine relative concentrations than the entire cohort.</p><p><strong>Discussion: </strong>The number of xylazine-positive and fentanyl-positive cases has increased over time, even as the relative concentrations of urine xylazine and fentanyl have gradually declined. This inverse trend suggests an increasing prevalence of xylazine and fentanyl exposure at progressively lower concentrations. Our data also indicated the association of urine xylazine concentrations with skin wounds and infections, but not with coma or post-cardiac arrest.</p><p><strong>Conclusions: </strong>The findings of this study highlight the increasing prevalence of xylazine in illicit drug use, particularly in combination with fentanyl, at our institution over time. More research is needed to elucidate the roles of xylazine on opioid intoxication.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}