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A motor vehicle accident fatality involving the inhalation of 1,1-difluoroethane.

A 24-year-old female driver with a history of substance abuse was pronounced dead following a single car motor vehicle accident. A surviving front seat passenger witnessed the decedent inhaling "Dust Off" cleaner just prior to losing control of the vehicle. The propellant compound used in this product is the halogenated hydrocarbon 1,1-difluoroethane (DFE). Sealed autopsy specimens were examined for the presence and subsequent quantitation of DFE utilizing an Agilent 6850 gas chromatograph (GC)-flame-ionization detector. The levels of DFE obtained were as follows: 29.8 mg/L in femoral blood, 40.3 mg/L in pulmonary arterial blood, 85.6 mg/L in aortic blood, 79.9 mg/L in chest cavity blood, 21.2 mg/L in vitreous, 11.7 mg/kg in brain, 27.9 mg/kg in liver, 71.0 mg/L in urine, and 51.8 mg/total gastric contents. The presence of DFE was confirmed in the decedent's urine by injection on an Agilent 6890/5973 GC-mass spectrometer in full scan mode. This case presents a uniquely witnessed observation of the apparent impairing effects and consequences of the acute inhalation of halogenated hydrocarbons such as DFE and the operation of a motor vehicle. The proximity of time of death to inhalant use may also provide insight to postmortem distribution patterns of DFE in relation to normal physiologic blood flow. With further investigations, estimating the time of final use of an inhalant prior to death may be deciphered from such patterns, although a degree of caution should be applied in deaths resulting from severe trauma in which normal tissue structure is compromised because postmortem redistribution may result.

Accidents, Traffic↗

Adolescent substance abuse and psychiatric comorbidities.

The use and abuse of substances-including alcohol, nicotine, marijuana, inhalants, and other drugs-are commonly found to be comorbid with psychiatric conditions in adolescents. This dual diagnosis requires special attention and treatment, especially as substance use often begins during this developmental period. Adolescents may be diagnosed with substance abuse, substance dependence, or substance use disorder not otherwise specified, which indicates a developing substance use problem that includes symptoms of but does not meet criteria for substance dependence. Psychiatric comorbidity in adolescents who abuse substances is the rule rather the exception, and common comorbidities include depression, anxiety, bipolar disorder, conduct disorder, and attention-deficit/hyperactivity disorder. Treatment of the psychiatric disorder often helps to alleviate the substance use disorder as well. This activity discusses the epidemiology, assessment, and treatment of this dual diagnosis.

Adolescent↗

Endotoxemia in sudden infant death syndrome.

Endotoxemia has been proposed as a significant cause of Sudden Infant Death Syndrome (SIDS). We examined postmortem sera from left and right heart samples of 21 SIDS cases (1989 definition) and 23 controls. The controls were < 1 year of age and had died suddenly and unexpectedly of infection, abuse, suffocation, blunt injury, or fire and smoke inhalation. Endotoxin was measured without knowledge of the clinical status by using a kinetic modification of the chromogenic limulus amoebocyte lysate assay. The SIDS cases had insignificant concentrations of endotoxin in serum, whereas some of the controls who experienced blunt injury, abuse, or severe infection exhibited moderately elevated concentrations. Postmortem interval and postmortem blood culture results did not materially affect endotoxin concentrations. Thus, we conclude that endotoxemia is not a substantial pathophysiologic event in SIDS.

Bacterial Infections↗

Relative addiction potential of major centrally-active drugs and drug classes--inhalants and anesthetics.

The inhalation of a wide variety of substances for recreational purposes is a health problem of worldwide proportions. The inhalation of non-narcotic agents, such as volatile inhalants (e.g., solvents and glues), anesthetics and nitrites, adds significantly to the growing number of substance abusers. This is of particular concern because it affects the younger members of the population, and the substances abused are, for the most part, legally obtainable. The toxicity of these inhaled substances are reviewed and compared, as are their potentials for addiction and dependence.

Administration, Inhalation↗

Complications following butane inhalation and flash fire.

Solvent inhalation is a well-documented form of drug abuse that can cause euphoria and hallucinations. Sudden death involving a volatile substance is most commonly caused by cardiac arrythmias, asphyxia, direct drug effects, and trauma. The victim in this paper suffered superficial partial thickness (12% total body surface area) burns from a flash fire that occurred when lighting a match after inhaling butane in an enclosed vehicle. The victim was admitted to the hospital for 2 days of observation but did not develop any respiratory symptoms under 2 days following her release. The victim died during her readmission, 9 days after the flash fire. Postmortem examination showed extensive epithelial injury from the upper airway and trachea to the terminal bronchioles, most likely due in part to both the initial inhalation injury and the resulting adult respiratory distress syndrome (ARDS) and staphylococcal infection. Many victims with superficial burn injuries may not seek medical attention owing to either embarrassment or fear of legal prosecution. Even those who do seek medical assistance may not reveal solvent abuse as the cause of their injuries. It is possible that delayed death may occur at home following volatile substance abuse but may remain unrecognized even with a thorough scene investigation.

Adolescent↗

Some ocular manifestations of systemic drug abuse.

Optometrists are increasingly likely to see patients who use illicit drugs, which may cause ocular signs which mimic other problems. This paper reviews pharmacologic effects on the eye of depressants, hallucinogens, inhalants, marijuana, opiates, and stimulants including amphetamines and cocaine. Drug abusers suffer from AIDS, CMV retinitis, fungal and bacterial endophthalmitis, quinine poisoning and talc retinopathy. The ocular signs and symptoms of these diseases are discussed. The most common presenting complaints in an optometric setting are emphasized.

Acquired Immunodeficiency Syndrome↗

Effect of toluene inhalation on astrocytes and neurotrophic factor in rat brain.

Toluene, an abused substance in Japan, is a neurotoxic chemical that has been shown to have neurobehavioral and electrophysiological effects. In previous work, both acute and chronic effects of toluene on cells have been studied extensively. However, although glial cells are thought to play an important role in the survival of neurons in the brain, the effect of toluene on glial cell function has not yet been characterized. To elucidate this, the effect of toluene inhalation on astrocytes in rat brain was examined. Toluene exposure (1500 ppm for 4 h on 4-10 days) augmented glial fibrillary acidic protein (GFAP) immunoreactivity, particularly in the hippocampus and cerebellum. Quantitative analysis showed that toluene inhalation markedly enhanced GFAP expression in the hippocampus and cerebellum. In both regions, proliferating cell nuclear antigen (PCNA) showed no obvious changes, but glutamine synthetase (GS)-immunoreactive cells were markedly increased by toluene exposure. Thus, the elevation of GFAP expression was induced by astrocyte activation rather than by cell proliferation. If toluene exposure activates astrocytes, astrocytes may play a role in the neurophysiological changes observed in toluene intoxication. A neurotrophic factor, basic fibroblast growth factor (b-FGF) was observed immunohistochemically in the capillary vessel walls in the hippocampus and the cerebellum of toluene-intoxicated rats. Basic-FGF may have induced GFAP expression both in the hippocampus and the cerebellum. So, other neurotrophic factors may affect the difference of GFAP elevation between the hippocampus and the cerebellum. These differences may relate to neurobehavioral function of each brain part after toluene exposure.

Acute Disease↗

Transient visual loss after amyl Isobutyl nitrite abuse.

PURPOSE: To report retinal alterations after Isobutyl nitrite (popper) inhalation. METHODS: Case Report. RESULTS: A 30-year-old man presented a sudden visual decrease following the use of Isobutyl nitrite (popper) while he was at a discotheque. His visual acuity (VA) was 20/50 in the right eye (RE) and 20/63 in the left eye (LE). Ophthalmoscopy revealed symmetric alteration of the foveal reflex with a small yellowish-white spot in the foveal area, much more evident in the RE. Fluorescein angiography and OCT were normal. Visual field showed a mild reduction of central differential light sensitivity. A progressive recovery was noted and at one month's follow-up VA was 20/25 in OU with very faint yellowish-white spots. CONCLUSIONS: The inhalation of drugs as "popper" may cause a visual loss by unclear mechanisms.

Adult↗

Glue sniffing: a pilot study of the cognitive effects of long-term use.

A psychological test battery briefly assessing memory, intelligence, and attention was administered to 10 delinquent solvent inhalers and 10 matched controls. The solvent abuse group showed significant impairment in tests of memory, nonverbal intelligence, and attention and concentration. The implications for future research are discussed.

Adolescent↗

Acute renal failure, anterior myocardial infarction, and atrial fibrillation complicating epinephrine abuse.

After injecting the solution extracted from a Primatene Mist inhaler, a patient experienced epinephrine overdose that resulted in an acute myocardial infarction and acute renal failure. The exact amount of epinephrine injected was unknown, but was thought to be between 82.5 and 124 mg, more than 25 times higher than the amount normally administered. Health care providers should be aware of this readily available source of epinephrine and the potential adverse effects associated with its inappropriate use.

Acute Kidney Injury↗

Anxiety-like behavior in mice in two apparatuses during withdrawal from chronic ethanol vapor inhalation.

BACKGROUND: Anxiety during ethanol withdrawal may be a factor in relapse to alcohol abuse and dependence. Animal models of ethanol withdrawal have typically used forced consumption of an ethanol-containing liquid diet to induce dependence. Ethanol vapor inhalation offers an advantage over liquid diet consumption in that the onset of withdrawal can be temporally controlled more precisely, allowing studies of the development of withdrawal symptoms. METHODS: The purpose of the current study was to induce ethanol dependence in mice using an inhalation procedure and to assess withdrawal anxiety symptoms behaviorally in the elevated zero maze and in the light/dark box. Male and female mice were exposed to 3 days of ethanol vapors. Anxiety-like behavior was measured on the elevated zero maze and light/dark box at multiple time points during withdrawal. RESULTS: Mice experiencing ethanol withdrawal demonstrated increased anxiety-like behaviors relative to control animals in both apparatuses. However, this finding was specific to the procedure used with the elevated zero maze and was strongly influenced by sex in the light/dark box. CONCLUSIONS: Ethanol vapor inhalation appears to be a valid tool for the study of withdrawal-induced anxiety.

Administration, Inhalation↗

Inhaled toluene produces pentobarbital-like discriminative stimulus effects in mice.

The abuse of volatile solvents may be due to their ability to produce an intoxication similar to that produced by classical central nervous system depressants such as the barbiturates and ethanol. To evaluate this hypothesis, mice were trained to discriminate pentobarbital from saline injections in a two-lever operant task. Stimulus generalization was examined following 20-min inhalation exposures to toluene (300-5400 ppm). In 8 of 10 subjects, pentobarbital-lever responding occurred following toluene exposure indicating an overlap in the discriminative stimulus properties of toluene and pentobarbital.

Aerosols↗

Effects of inhaled 1,1,1-trichloroethane on locomotor activity in mice.

To quantify the motoric effects of an abused solvent, photocells were added to two exposure systems. The first system utilized a static exposure chamber that recirculated vapor-laden air. A second dynamic system allowed for removal of waste gases with replenishment of fresh air combined with test vapors. In the present studies, male mice were examined for effects on locomotor activity following 30-min inhalation exposures to several concentrations of 1,1,1-trichloroethane (TCE), a widely used and abused solvent. TCE produced significant increases in locomotor activity at intermediate concentrations. Minimally effective concentrations for activity-increasing effects in the dynamic and static systems were 1,250 ppm and 2,500 ppm, respectively. At higher concentrations, motor activity was decreased with the highest dynamic system concentration (10,000 ppm), resulting in 26% of baseline control values. Biphasic, motor activity increasing and decreasing effects of TCE as a function of exposure concentration may reflect the CNS-depressant drug-like effects of abused solvents.

Administration, Inhalation↗

Drug problem in southeast and southwest Asia.

In 2002, the drug problem in Southeast and Southwest Asia was serious, particularly in the production of opium and heroin in Afghanistan, Myanmar, and Laos, the three largest producers of illicit opium in the world. The increasing illicit manufacture of ATS, particularly methamphetamine, in Southeast Asia, mainly in China and Myanmar, was also a major concern. Some reports indicated that ephedrine, used for illicitly producing methamphetamine in Southeast Asia, is diverted and smuggled out of China and India, whereas caffeine, the adulterant used for producing methamphetamine tablets, is mainly smuggled into Myanmar through its border with Thailand. Seizure data showed a dramatic increase in trafficking in MDMA through Southeast Asia. In terms of the drug epidemic, in 2002, cannabis remained overall the main drug of abuse in all of the countries of Southeast and Southwest Asia. Opiates, mainly opium and heroin, were also the drugs of choice except in Thailand, where opiate abuse declined, but ATS was the main drug of abuse due to its low cost and availability. A significant increase in ATS abuse, amphetamine, methamphetamine, and MDMA among the youth who smoked, sniffed, and inhaled them was reported in Cambodia, China, Indonesia, Laos, Myanmar, the Philippines, and Thailand. Injecting drug use among opiate abusers has been identified as the prime cause of the rapid spread of HIV/AIDS in Southeast and Southwest Asia.

Asia, Southeastern↗

Adolescent abuse of other drugs.

This article provides a general overview of other drugs of abuse within the adolescent population. Stimulants, hallucinogens, club drugs, inhalants, sedative-hypnotics, tranquilizers, opiates, and ergogenic drugs are included. Epidemiology, pharmacology, clinical aspects, laboratory, and treatment issues are addressed. Attention is focused on most commonly used drugs or representative drugs within each category. Review of alcohol, marijuana, and tobacco abuse can be found in other articles.

Adolescent↗

Muscle relaxants; their use and abuse in anesthesia.

Probably the most widely used anesthetic today is the intravenous-inhalant-relaxant combination. The relaxant drugs are the key to this combination. Lack of knowledge of the pharmacology of these drugs, their effect on circulation and respiration and of the physiology of respiration can seriously abuse and impair the evident value of this method. It should not be used routinely to the exclusion of equally valuable techniques that might serve better in some circumstances.

Administration, Intravenous↗

Crack lung: pulmonary disease caused by cocaine abuse.

A patient developed 3 separate episodes of fever, transient pulmonary infiltrates, and bronchospasm after inhalation of cocaine. The illness was associated with eosinophilia, pruritus, and an elevated IgE level, indicating an immunologic pathogenetic mechanism. This is a complication of cocaine abuse not previously reported.

Cocaine↗

Inhalant use among antisocial youth: prevalence and correlates.

The current (2.9%), annual (19.6%), and lifetime (34.3%) prevalence of inhalant use among 475 youth (M age = 15.5; SD = 1.5; 87.4% male) on probation in a western state of the United States was assessed. Inhalant users reported significantly less family support and cohesiveness and lower self-esteem, and significantly more lifetime thoughts of suicide and suicide attempts, neighborhood gang activity, peer and parental substance abuse, intentions to engage in illegal behavior, substance-related criminality, and substance abuse than did nonusers. Ethnicity, self-esteem, suicidality, number of substance-using peers, and extent of substance-related criminality significantly discriminated inhalant users from nonusers in a logistic regression analysis. Multiple linear regression analyses indicated that age, perceived school ability, age at initiation of alcohol use, self-esteem, and substance-related criminality significantly predicted age at onset of inhalant use (R2 = .30). Age at initiation of inhalant use, gang membership, truancy, and substance-related criminality significantly predicted lifetime frequency of inhalant use (R2 = .20). Study findings indicate that inhalant-using delinquents evidence significantly greater antisocial attitudes, personal and familial dysfunction, and substance abuse, than do their non-inhalant-using counterparts.

Administration, Inhalation↗