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PubMed2001

Simultaneous determination of fluorinated inhalation anesthetics in blood by gas chromatography-mass spectrometry combined with a headspace autosampler.

Although the fluorinated inhalation anesthetics, including desflurane, sevoflurane, isoflurane, enflurane, and halothane are commonly used, fatal cases resulting from their abuse or misuse have been reported. To date, gas chromatography (GC) equipped with different kinds of detectors has been utilized to analyze inhalation anesthetics. However, none of them can detect desflurane reliably or analyze all five common anesthetics simultaneously. The purpose of the present work is to further modify the previously developed headspace (HS) GC-MS method for blood isoflurane determination to analyze and distinguish five common clinical inhalation anesthetics, simultaneously. The modified HS-GC-MS method adopts a 60 m x 0.25 mm I.D., 0.25 microm film thickness DB-5 capillary column along with an adequate GC temperature program, which gives the five inhalation anesthetics, including isoflurane and its isomer, enflurane, a high resolution. The method also takes both the volatility and the influence of the top space on the obtained concentration into consideration and therefore keeps the sample loss acceptable even for analyzing the highly volatile desflurane. Within a certain concentration range of the calibration standard (about 20-300 microg/ml), this method shows a good linearity with correlation coefficients greater than 0.999. In addition, both within- and between-run precision and accuracy results meet the validation requirements as well as the tested results of practical blood samples of desflurane. In summary, this is a reliable analytical method to simultaneously determine the concentration of five common inhalation anesthetics in blood. Such a method is very practical for both clinical and occupational monitoring, as well as for analytical toxicology.

Anesthetics, Inhalation↗
PubMed2004

"Whippets"-induced cobalamin deficiency manifesting as cervical myelopathy.

BACKGROUND: Nitrous oxide (N2O) is inhaled in anesthesia and as a recreational drug from whipped cream dispensers. Its abuse reaches approximately 10% in some age groups. By inactivating cobalamin (Cbl) (vitamin B12), N2O can cause neurologic and hematologic manifestations. We present a case of N2O-induced Cbl deficiency presenting as cervical myelopathy. CASE HISTORY: After regularly inhaling N2O for many months, a 31-year-old man developed limb paresthesiae and ataxia over 3 months. Examination revealed finger pseudoathetosis, hyporeflexia, decreased sensation, and gait ataxia. Brain magnetic resonance imaging (MRI) was normal, but the posterior columns of the cervical and upper thoracic cord revealed patchy nonenhancing hyperintense lesions. Serum Cbl was 98 pg/mL (normal = 170-900 pg/mL). Cbl replacement led to recovery within 3 months. DISCUSSION: This patient presented with the symptoms and signs of Cbl deficiency. The MRI lesions in the posterior columns aided the diagnosis. Physicians need to have a high level of suspicion in cases of unexplained Cbl deficiency and myelopathy.

Adult↗
PubMed1987

Pneumomediastinum, pneumothorax, and subcutaneous emphysema after alternate cocaine inhalation and marijuana smoking.

Previous reports have indicated the association of marijuana and cocaine abuse along with prolonged Valsalva maneuvers and the use of positive pressure devices. In most cases, the use of a single drug has been related to barotrauma. We present an adolescent male who developed this complication after alternate use of marijuana and cocaine without positive pressure devices. The increasing problem of drug abuse in the adolescent population in the United States is known to all of us. Clinicians who deal with adolescent patients should include questioning about drug abuse in the standard evaluation of chest pain.

Adolescent↗
PubMed1995

Accidental death by nitrous oxide inhalation.

Nitrous oxide is a popular inhalation anesthetic-analgesic agent. Its euphoric action and its availability have led to its abuse. We report a case of fatal accidental asphyxia due to nitrous oxide abuse. The deceased was a hospital worker who had access to the hospital supply of nitrous oxide. His death was due to hypoxemia and asphyxiation, secondary to nitrous oxide inhalation.

Adult↗
PubMed2001

Neurologic problems associated with chronic nitrous oxide abuse in a non-healthcare worker.

Chronic exposure to nitrous oxide (N2O) is known to be associated with hematologic and neurologic abnormalities. When this syndrome occurs, it is generally seen in health care workers, especially dentists and anesthesiologists, who have access to nitrous oxide. Here, however, we report a case of a 55-year-old non-healthcare worker who presented with multiple neurological abnormalities. His serum vitamin B12 level was low but his Shilling test was normal. His neurologic symptoms improved after cessation of inhaling nitrous oxide and starting vitamin B12 therapy. Physicians should consider nitrous oxide abuse in non-healthcare workers presenting with neurologic symptom of unclear cause.

Humans↗
PubMed2005

High prevalence of substance use disorders among adolescents who use marijuana and inhalants.

BACKGROUND: We examined the association between the use of inhalants, marijuana, and other drugs and recent DSM-IV substance use disorders among adolescents aged 12-17 years. METHODS: Data were drawn from 2000 to 2001 National Household Surveys on Drug Abuse. Adolescents aged 12-17 years who reported having ever used an illicit drug in their lifetime were categorized into four mutually exclusive groups: inhalant users (16%), marijuana users (53%), inhalant and marijuana users (16%), and other drug users (15%). Logistic regression models were used to estimate associations with recent substance use diagnoses among lifetime adolescent drug users (N=10,180). RESULTS: We found that 31% of lifetime drug users reported having never used marijuana. One half of these atypical drug users were predominantly nonmedical users of pain relievers. Adolescents who used inhalants or other drugs but not marijuana were least likely to report multidrug use. Adolescents who reported using both inhalants and marijuana were most likely to use three or more classes of drugs (73%) and to receive a diagnosis of past year alcohol (35%) and drug (39%) abuse or dependence. CONCLUSIONS: Our study findings suggest that among lifetime adolescent drug users, those who use both inhalants and marijuana are at very high risk for alcohol and drug use disorders.

Administration, Inhalation↗
PubMed1994

The effects of high-dose toluene on embryonic development in the rat.

Developmental disability, intrauterine growth retardation, renal anomalies, and dysmorphic features have been described in offspring of women who abuse toluene during pregnancy. A Sprague-Dawley rat model was developed to study this clinical syndrome. During d 6-19 of gestation, 11 treated dams received daily gavage doses of toluene, 520 mg/kg body weight, diluted in corn oil, and 11 control dams received corn oil. This dose of toluene simulates the blood toluene levels obtained after an inhalation exposure to 3290 ppm toluene, an inhalation level in the lower end of the range experienced by toluene abusers. Maternal weight gain was 24% less in the toluene-exposed group (p < 0.002); however, there were no maternal deaths. The fetuses were delivered on d 19 of gestation, and 287 fetuses (148 toluene exposed, 139 control) were examined. Toluene treatment did not affect the number of implantations or stillbirths. There were no toluene-induced major congenital malformations or neuropathologic changes noted. In the toluene-treated group, the weights of the fetuses were reduced by 9.4% (p < 0.004) and placental weights were reduced by 10.3% (p < 0.01). Toluene exposure also reduced fetal organ weights as follows: brain 4.6%, heart 5.9%, liver 13.2% (p < 0.02), and kidney 13% (p < 0.05). Organ weight/body weight ratios did not differ significantly, suggesting that prenatal toluene exposure produced a generalized growth retardation.

Animals↗
PubMed2005

Vocal process granuloma: clinical characterization, treatment and evolution.

UNLABELLED: Vocal process granuloma is a disease whose etiopathogenesis is not well defined. Therefore, its clinical and surgical treatment is not standardized and its therapeutic results depend on the hospital where it is seen. AIM: Aiming to characterize patients with vocal process granuloma treated in our hospital, the therapeutic approach used and clinical evolution. MATERIAL AND METHOD: We performed a retrospective review of records. RESULTS: We found more male vocal process granuloma, except when associated with laryngeal intubation. The most frequent related etiopathogenic factor was laryngeal-pharynx reflux, followed by laryngeal intubation and vocal abuse. Clinical management with proton-pump inhibitor (PPI), topical inhalant steroid and phonotherapy was enough for remission on 48.6% of the patients. Surgery for removal of the granuloma associated with clinical management was effective in 90% of the events. Later recurrences (more than one year) were noticed in five patients, suggesting that associated etiopathogenic factors should be held for a long time.

Adult↗
PubMed2005

Investigation of fatalities due to acute gasoline poisoning.

This paper presents a simple, rapid, reliable, and validated method suited for forensic examination of gasoline in biological samples. The proposed methodology has been applied to the investigation of four fatal cases due to gasoline poisoning that occurred in Spain in 2003 and 2004. Case histories and pathological and toxicological findings are described in order to illustrate the danger of gasoline exposure under several circumstances. Gasoline's tissular distribution, its quantitative toxicological significance, and the possible mechanisms leading to death are also discussed. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography (GC) with flame-ionization detection, and confirmation was performed using GC-mass spectrometry in total ion chromatogram mode. m,p-Xylene peak was selected to estimate gasoline in all biological samples. Gasoline analytical methodology was validated at five concentration levels from 1 to 100 mg/L. The method provided extraction recoveries between 77.6% and 98.3%. The limit of detection was 0.3 mg/L, and the limit of quantitation was 1.0 mg/L. The linearity of the blood calibration curves was excellent with r2 values of > 0.997. Intraday and interday precisions had a coefficient of variation < or = 5.4% in all cases. Cases 1 and 2 consist of the accidental inhalation of gasoline vapor inside a small enclosed space. Case 3 is a death by recreational gasoline inhalation in a male adolescent. Heart blood concentrations were 28.4, 18.0, and 38.3 mg/L, respectively; liver concentrations were 41.4, 52.9, and 124.2 mg/kg, respectively; and lung concentrations were 5.6, 8.4, and 39.3 mg/kg, respectively. Case 4 was an accidental death due to gasoline ingestion of a woman with senile dementia. Peripheral blood concentration was 122.4 mg/L, the highest in our experience. Because pathological findings were consistent with other reports of gasoline intoxication and constituents of gasoline were found in the body, cause of death was attributed to acute gasoline intoxication. As a rule, this kind of poisoning offers little difficulty in diagnosis because there is a history of exposure, and the odor usually clings to the clothes, skin, or gastric contents. However, anatomic autopsy findings will be nonspecific and therefore toxicological analysis is necessary. There is a paucity of recent references regarding analytical and toxicological data, and this article provides evidence about toxic concentrations and is a useful adjunct to the postmortem toxicological interpretation of fatalities if the decedent has been involved in gasoline use.

Accidents, Occupational↗
PubMed1984

Nonurban male homosexuals: epidemiologic, immunologic and virologic characteristics.

Twenty asymptomatic male homosexuals living in North Carolina were evaluated looking at epidemiologic, immunologic and virologic characteristics. In ten subjects selected for inhalant nitrite use a significantly higher frequency of multiple drug abuse and a trend toward greater sexual promiscuity was found in comparison with ten nonnitrite users. None of the 20 subjects had chronic lymphadenopathy. Cytomegalovirus (CMV) was not found in urine, blood or throat washings, but was found in 29% of the subjects' semen specimens--a finding that was significantly linked (P less than .05) to the presence of CMV IgM antibody in serum. There were no abnormal helper lymphocytes: suppressor T lymphocyte ratios (all greater than 1.3) and lymphocyte mitogen stimulations were not different from heterosexual controls in contrast to frequent abnormalities reported in male homosexuals in metropolitan areas. If these immunologic findings are reproducible, they may be important in understanding why the Acquired Immunodeficiency Syndrome has clustered in large cities.

Adult↗
PubMed1989

Japan: stimulant epidemics past and present.

Japan experienced a serious stimulant epidemic during the period from 1946 to 1956 and has been experiencing a second one since 1970. Over the years, a series of drug control measures have been put into effect by the Japanese Government. In 1953, the Japanese police system was reorganized, centralized and made more efficient. Law enforcement efforts were intensified, supported by the criminalization of stimulant abuse with the enactment of the Stimulant Control Law in 1951 and subsequent amendments to it that were rigorously enforced, resulting in more arrests, indictments and relatively harsh penalties for stimulant offences, as well as an increase in the number and volume of confiscations. In 1951, 26 per cent of those arrested for stimulant offences were under the age of 20. About half of those arrested were stimulant-addicted. The number of arrests increased threefold from 1951 to 1954. The amount of seized stimulants also increased considerably during that period. In 1954, there were about 550,000 chronic stimulant users and 2 million ex-users. From 1980 to 1985, the number of stimulant arrests was relatively stable, levelling off at about 20,000 annually. About half of those arrested were recidivists. In 1985, a record high of nearly 300 kg of stimulants were seized. In 1960, heavy usage of sleeping pills among young persons began in Tokyo; this was considered a foreshadowing of a period of youth drug abuse in Japan. In 1967, there was an outbreak of inhalant use among young people; since 1975, about 40,000 people have been arrested each year for inhalant-related offences.

Adolescent↗
PubMed1984

Abuse of a fire-extinguishing agent and sudden death in adolescents.

Two cases of abuse of bromochlorodifluoromethane (BCF - a fire-extinguishing agent) by inhalation are reported. In the first case, a 15-year-old youth presented in ventricular fibrillation; the second youth was dead on arrival at hospital. Port-mortem toxicological investigations confirmed BCF inhalation in the latter patient. Management of the surviving patient included cardioversion, controlled mandatory hyperventilation, intravenous infusions of mannitol, and barbiturate protection against cerebral ischaemia. He had completely recovered after eight days. Community agencies report that BCF inhalation occurs frequently on the Gold Coast, Queensland. This behaviour can be associated with sudden death from ventricular arrhythmias after cardiac sensitization to endogenous adrenaline. The "lone sniffer" is at greatest risk, and identification of such individuals may prevent a fatal outcome.

Adolescent↗
PubMed1998

A direct comparison of inhalant effects on locomotor activity and schedule-controlled behavior in mice.

Increases in rates of rodent behavior have been commonly seen with exposure to abused vapors. In the 1st study, 30-min exposures to vapors of toluene, trichloroethane (TCE), or methoxyflurane produced increases in locomotor activity of mice at lower concentrations and decreases at higher concentrations. In the 2nd study, the effects of these vapors on schedule-controlled behavior were determined in mice lever pressing under a multiple fixed-ratio, 20-fixed interval (FI), 3-min schedule. Only concentration-related decreases in response rates were obtained in both components. In the 3rd study, toluene and TCE again produced only decreases in rates of responding under a simple FI 3-min schedule; biphasic effects were produced by methoxyflurane and amyl nitrite. The increases in rates of behavior often seen with abused vapors depend on the testing conditions.

Animals↗
PubMed1990

Successful out-of-hospital defibrillation for ventricular fibrillation complicating solvent abuse.

The Authors describe the case history of a child who suffered a cardiac arrest with ventricular fibrillation after deliberate inhalation of 1,1,1-Trichloroethane in typewriter correction fluid thinners. Successful out-of-hospital defibrillation was carried out and the patient made a full recovery. The literature relating to this particular form of volatile substance abuse is reviewed.

Child↗
PubMed2006

Inhalational model of cocaine exposure in mice: neuroteratological effects.

We developed a novel inhalation-based mouse model of prenatal cocaine exposure. This model approximates cocaine abuse via smoking, the preferred route of cocaine administration by heavy drug users. The model is also characterized by (i) absence of procedural stress from drug administration, (ii) long-term drug exposure starting weeks before pregnancy and continuing throughout the entire gestation, and (iii) self-administration of cocaine in multi-hour daily sessions reminiscent of drug binges, which allows animals to set up the levels of their own drug consumption. The offspring of female mice inhaling cocaine in our model displayed no gross alterations in their cortical cytoarchitecture. These offspring, however, showed significant impairments in sustained attention and spatial working memory. We hope that the introduction of the present model will lead to a significant increase in our understanding of outcomes of prenatal cocaine exposure.

Administration, Inhalation↗
PubMed2002

Toluene inhalation produces regionally specific changes in extracellular dopamine.

The aim of the present study was to investigate the effect of toluene inhalation on dopaminergic transmission in two distinct brain areas presumably involved in mediating the reward processes important for toluene abuse. Extracellular dopamine (DA) levels were measured in prefrontal cortex (PFC) and nucleus accumbens (NACC) of freely moving rats using in vivo microdialysis. Inhalation of a behaviorally relevant concentration of toluene (3000 ppm) produced a significant increase in the PFC but not in the NACC. However, the odorant isoamyl acetate, increased PFC DA levels by only 37%, significantly less than the 96% increase observed following toluene exposure. When toluene inhalation was combined with cocaine administration (20 mg/kg i.p.), the response to the combined challenge was not different from the response to toluene alone in the PFC. However, the combination of these two drugs produced a supradditive response of 802% in the NACC, compared with the 450% increase observed following cocaine alone. Recent reports indicate that toluene influences the function of several ionotropic receptors in a subunit specific manner. As further evidence of specific effects, our results indicate regionally specific changes in dopaminergic transmission following toluene exposure.

Administration, Inhalation↗