A fatal case report of acute yohimbine intoxication

Abstract

Yohimbine is an indole alkaloid extracted from the bark of the Pausinystalia yohimbe tree, which has found a clinical application through the treatment of erectile dysfunction. Yohimbine is also widely used by the bodybuilding community for its sympathomimetic effects and its presumed lipolytic effects. This substance is, however, associated with adverse effects, including cardiac and neurologic side-effects, but only few fatal cases have been described to date. In this context, this manuscript aims at documenting a fatal case of a 27-year-old male. Ethanol concentration determination and toxicological screening were performed using gas chromatography with flame ionization detection, liquid chromatography with diode array detection and gas chromatography with mass spectrometry detection. Liquid chromatography with diode array detection allowed the quantification of yohimbine. Toxicological analysis of subclavian blood, vitreous humor, and urine samples highlighted the presence of yohimbine and tramadol. Yohimbine was quantified at the concentration of 8000 µg/L in the peripheral blood and 2600 µg/L in the vitreous humor. Tramadol blood concentration was below the toxic threshold. Only a very few number of yohimbine fatalities has been reported so far. In the current case, yohimbine acute intoxication appeared to be the most likely cause of death. In fact, the blood concentration highlighted here is the highest ever reported to date.