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PubMed1988

Fatal pepper aspiration.

Eight patients (five previously undescribed) died due to aspiration of pepper. Seven deaths involved homicides, and one death was accidental in a child with documented pica. The pepper was administered by the mothers in three children and by a foster mother, the mother's boyfriend, an adult male friend, and the child's godfather in one case each. Homicidal pepper aspiration shares many of the features of more conventional child abuse: in each instance, the child was being punished, four of the seven assailants initially gave incorrect histories, and four children were chronically abused. The facts that each death occurred in a different state and that five of the seven homicides occurred within the two years preceding the preparation of this report suggest that this form of child abuse is not confined to any single part of the country and may be increasing in infrequency.

Asphyxia↗
PubMed1989

Suicide by nitrous oxide poisoning.

Fatal nitrous oxide poisoning usually occurs accidentally during the administration of general anesthesia. It seldom occurs during autoerotic behavior or in acute drug abuse. We report an unusual case of a health professional who committed suicide by inhaling nitrous oxide.

Adult↗
PubMed2006

NMR regulatory analysis: enantiomeric purity determination for (R)-(-)-desoxyephedrine and antipode methamphetamine.

Regulatory enantiomeric purity direct determination for (S)-(+)-methamphetamine, the widely abused DEA schedule II controlled substance, and (R)-(-)-desoxyephedrine, over-the-counter nasal inhaler decongestant were developed using 400 MHz 1H NMR spectroscopy. The efficient enantiomeric differentiation was obtained using a diamagnetic chiral solvating agent to dissimilarly perturb the NMR spectra of the enantiomeric solutes. Nonequivalence behavior was studied in terms of all variables that affect population and intrinsic spectra of the fast diastereomeric solvates. Assignment of enantiomer configuration was based on the relative field position of the resolved enantiomeric signals. Optimization of experimental conditions provided significant resolved enantiomeric signals suitable for quantification. Utilizing the relative intensities of the corresponding enantiomeric signals of the N-CH3 assigned to (S)-(+)-methamphetamine and (R)-(-)-desoxyephedrine, the analysis of synthetic enantiomeric mixtures by the proposed methods demonstrated excellent agreements with the known values of the enantiomers present. The mean +/- SD recovery values for the (R)-(-)-enantiomer was 99.9 +/- 0.4% of added antipode (n = 7). The optically pure enantiomer was used to establish the minimum amount detected by the proposed NMR spectroscopic method.

Algorithms↗
PubMed1996

Drug abuse among urban as compared to rural secondary schools students in Kenya: a short communication.

In a comparative study of drug abuse in Urban versus Rural secondary schools, 952 students (547 Urban and 405 rural) were subjected to the WHO youth survey questionnaire. It was found that male students abused drugs more often than female students. Alcohol emerged as the most commonly abused drug (15% and 14% in urban and rural schools respectively). Tobacco, cannabis and inhalants followed in that order. The "hard' drugs were more commonly used in the rural schools.

Adolescent↗
PubMedDate not supplied

Volatile substance abuse: a brief report.

Volatile substance abuse (VSA) is on the increase: the practice is widespread among young people and concern has often been expressed about its potential dangers. It is estimated that in the United Kingdom between 3.5-10% of current adolescents have at least experimented with solvents, and up to 1% of the secondary school population are currently abusers. Adequate assessment of each individual case is essential as this will lead to appropriate therapeutic interventions and rational management of associated problems.

Administration, Inhalation↗
PubMed1991

Detection of anticardiolipin antibody in patients with cocaine abuse.

Anticardiolipin antibody, an immunoglobulin that binds negatively charged phospholipids, is considered to be an in vitro inhibitor of clot-based coagulation procedures. We adapted an enzyme immunoassay using stationary cardiolipin antigen to compare anticardiolipin antibody activity in the plasma of 44 cocaine abusers with its activity in the serum of 72 blood donors and a sample of 203 random specimens from healthy volunteers. Activity of 20 of the 44 abusers and 43 of 203 random specimens exceeded the donor control reference range. Patients using intravenous cocaine were more likely to have elevated activity than those who inhaled (P less than 0.05). Of 7 patients who had seizures or thromboembolic disorders, 5 were anticardiolipin antibody positive. Enzyme immunoassay may have predictive value for ischemic disease in cocaine abusers.

Adult↗
PubMed2004

The distribution of sevoflurane in a sevoflurane induced death.

The distribution of sevoflurane (fluoromethyl 2,2,2,-trifluoro-1-(trifluoromethyl) ethyl ether) in blood, urine, liver, kidney, vitreous humor, and tracheal aspirate is presented from a subject with a sevoflurane induced death. Sevoflurane is a nonflammable general anesthetic administered by inhalation of vaporized liquid. Although general inhalation anesthetics have the potential to be fatal if not properly administered, the incidence of abuse is minute in comparison to other illicit drugs. Currently, there are no citations in the literature defining the body distribution of sevoflurane in a sevoflurane induced death. The decedent was found lying in a bed with an oxygen mask containing a gauze pad secured to his face. Three empty bottles and one partially full bottle of Ultane (sevoflurane) were found with the body in addition to two pill boxes containing a variety of prescription and non-prescription drugs. Serum, urine and gastric contents from the deceased were screened for numerous drugs and metabolites using a combination of thin layer chromatographic, colorimetric and immunoassay techniques. Analysis of biological specimens from the deceased revealed the presence of: amphetamine, caffeine, pseudoephedrine, nicotine, nicotine metabolite, and valproic acid. Sevoflurane concentrations were determined by headspace gas chromatography with flame ionization detection and revealed concentrations of 26.2 microg/mL in the blood, 105 microg/mL in the urine, 31.9 microg/mL in the tracheal aspirate, 86.7 microg/mL in the vitreous humor, 30.8 mg/kg in the liver, and 12.8 mg/kg in the kidney. The decedent had pathologies consistent with respiratory suppression including pulmonary atelectasis, pulmonary edema, and neck vein distention. The official cause of death was respiratory suppression by sevoflurane and the manner of death was unclear.

Adult↗
PubMed1998

Ventricular fibrillation following butane gas inhalation.

We report a case of out of hospital defibrillation in a 15-year-old schoolgirl who developed ventricular fibrillation (VF) in association with butane gas inhalation. Although defibrillation performed by an attending paramedic was successful in restoring a cardiac output, her clinical course was complicated by severe neurological impairment. Reports of successful resuscitation following volatile substance abuse are rare and we believe this is the first documented evidence of VF associated with butane gas. This case illustrates the tragedy of such abuse in fit young people and we briefly review the literature.

Administration, Inhalation↗
PubMed1995

Sudden cardiac death and substance abuse.

There has been a steady increase in the number of deaths occurring from volatile substance abuse per year. The majority of deaths are in males, the peak age group being 15-19 years. Fuel gases i.e. cigarette lighter refills (butane), propane and gasoline and other solvents such as typewriter correction fluid, dry-cleaning fluids (trichloroethane) and fire extinguishers (bromochlorodifluoromethane) are responsible for approximately 60% of these deaths. Volatile substances sensitise the heart to circulating catecholamines, such that sudden alarm or exercise may precipitate sudden death. The main mechanism of cardiac arrest is a cardiac arrhythmia, but anoxia, respiratory depression and vagal stimulation along with aspiration of vomit or trauma may be contributing factors to the sudden death. In addition, particularly butane gas inhalation may be associated with severe laryngeal oedema and laryngospasm. Resuscitation from sudden death associated with volatile substance abuse is rare, since the majority of deaths are unwitnessed. It is suggested that cardiac arrhythmias should be treated conventionally. Sympathomimetic drugs should be avoided. Early during the resuscitation process, beta-adrenergic blocking agents should be administered to protect the catecholamine-sensitised heart. Early intubation in the management of the cardiac arrest should be avoided, if the inhalational agent is known to be associated with laryngospasm.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed2006

Intraoperative epoprostenol and nitric oxide for severe pulmonary hypertension during orthotopic liver transplantation: a case report and review of the literature.

BACKGROUND: The presence of pulmonary hypertension in patients scheduled for liver transplantation requires a comprehensive perioperative heart evaluation and treatment with epoprostenol (prostacycline) infusion until a liver donor becomes available. We contended that intraoperative attenuation of severe pulmonary hypertension could be achieved by epoprostenol infusion combined with nitric oxide inhalation. CASE REPORT: A 49 years old man with end stage liver disease secondary to hepatitis C and ethanol abuse presented for orthotopic liver transplantation. The case was complicated by severe pulmonary hypertension. Preoperative epoprostenol, at doses ranging from 6 to 26 ng.kg(-1).min(-1), was infused during the induction of anesthesia. Although lower than before (>70 mmHg), post-induction pulmonary pressure (by Swan-Ganz catheter) was 62/30 mmHg. Prior to surgical incision nitric oxide (NO) by inhalation was commenced, increasing the concentration from 10 to 40 ppm; pulmonary artery pressure (PAP) then declined to 55/25 mmHg. Before starting reperfusion of the transplanted liver, NO concentration was increased to 80 ppm: this allowed completion of the procedure with PAP at 32/16 mmHg. Real time transesophageal echocardiography indicated improvement in right heart function due to NO. Following surgery, NO was continued for 10 hs at a concentration of 40 ppm and the patient was then extubated. Epoprostenol infusion was continued for 2 months after the patient was discharged home; last PAP was measured 32/10 mmHg. CONCLUSIONS: Severe intraoperative pulmonary hypertension during liver transplantation was successfully treated using the combination of IV epoprostenol infusion and NO inhalation in medium and high concentrations.

Administration, Inhalation↗
PubMed1990

[Methamphetamine abuse by smoking].

Three cases of methamphetamine abuse by smoking were reported. The oral intake and the intravenous injection of the drug are usually adopted, and the smoking is recently found among the stimulant abusers in Japan. The stimulant is heated on a piece of aluminium foil with a lighter and its smoke is inhaled with a straw or a paper pipe. The intake means are identical to "crystal or ice" in Hawaii, although a special glass pipe or a cigarette is not used here. The effect of the drug obtained by smoking is more slack and mild than that by a intravenous injection, although the drug of the double dose is used in the smoking. Two cases changed the intake means from the injection to the smoking because of no guilty feeling and a lack of injection marks and evident proofs of illegal use. Therefore, abuse of methamphetamine by smoking is thought to increase in near future in Japan, and the delusion of arrest by policemen observed frequently in the stimulant abusers maybe decreases as a result of a decrease in the psychological stress of guilty.

Administration, Inhalation↗
PubMed1994

Experimental estimation of addictive potential of a mixture of organic solvents.

In the present study we investigated in rats the reinforcing properties of glue vapours which are a mixture of four organic solvents (toluene 25%, benzine fraction 37%, ethyl acetate 31% and methylene chloride 7%). This mixture is used as a glue thinner and is a very popular among glue-sniffing children. Immediately after inhalation at a concentration of 7200 ppm, the glue vapours increased locomotor activity in the open field and response rate of self-stimulation in the lateral hypothalamus. Contrary to classical drug abuse, glue vapours enhanced the threshold current of self-stimulation. While the response rate of self-stimulation decreased to the control level 30 min after inhalation, the threshold current was still enhanced. Increasing the concentration of the vapours produced a decrease in response rate of self-stimulation and locomotor activity. When glue vapours were inhaled at a concentration of 14,400 ppm and higher, the response rate of self-stimulation was completely suppressed. The discriminative stimulus effects of the glue vapours appeared to be similar to those of general anaesthetics such as ether and pentobarbital. At vapour concentrations of 7200 and 14,400 ppm, conditioned place preference was established. The ability of solvents to reinforce conditioning in the place preference paradigm and to activate the brain reward system in intracranial self-stimulation experiments may be useful for predicting the addictive potential of inhalants.

Administration, Inhalation↗
PubMed1987

The abuse of volatile substances.

Volatile substances have been used to alter consciousness since ancient times. Societal trends have brought forth one inhalant fad after another. It would be reasonable to expect this pattern to change as certain of the inhalants come under greater control or become less available (e.g., leaded gasoline). Experimentation with these agents among younger adolescents probably will continue, and for this reason, pediatric practitioners should be aware of the use of these agents and their potential toxicities.

Adolescent↗
PubMed1992

[Epidemiology of alcohol and drug abuse in Paraguay].

The results of a prevalence study on use- and abuse- of psychoactive substances, among a population aged 12 to 45 in Paraguay are presented. Presence of the depressive syndrome as well as attitudes and beliefs related to the use of psychoactive substances were also investigated. A bilingual questionnaire was drafted--i.e. a Spanish version and a Guarani version due to the Paraguayans' bilingual characteristic--that yielded acceptable validity and reliability levels. A stratified random sample was applied, with a total of 2,504 questionnaires filled out. Weighted data are shown here as studied by sex, age-group, socio-economic level, and presence of the depressive syndrome. Substance/alcohol use patterns were found out to be widely tolerant about abusing legal substances such as alcohol, tobacco, and psychotropic drugs. As regards illicit substances use, inhalants head the list followed by marijuana at a close range.

Adolescent↗
PubMed1984

Cocaine abuse and its treatment.

Increasing numbers of individuals with a diagnosis of cocaine abuse (DSM-III, 305.6) are seeking medical and psychiatric care. The majority of users inhale the drug in powdered form, as cocaine is rapidly absorbed by mucous membranes. The patterns of use resemble those for the use of alcohol and marijuana: recreational, intensified, circumstantial, and compulsive. When cocaine is taken intravenously or by freebasing, individuals are much more vulnerable to developing a compulsive pattern of use that could lead to an organic delusional syndrome. Cocaine causes systemic effects that are similar to those of amphetamine, but they have a much shorter duration of action. Blood pressure, heart rate, feelings of "pleasantness" and "stimulation" are increased, and hunger is decreased. Acute tolerance may develop over hours of continuous use, but it disappears after a short period of abstinence (overnight). In psychomotor testing, performance that is impaired by fatigue is restored to baseline levels. Users like cocaine because they feel more alert, energetic, sociable, and sensual. However, these positive feelings are commonly followed by anxiety, depression, irritability, fatigue, and craving more cocaine. Chronic intoxication is always associated with adverse psychosocial sequelae. Treatment initially must be directed toward the patient's stopping all use of cocaine, employing strategies such as contingency contracts, urinalysis, family intervention, the assignment of financial control to others, or hospitalization. Several psychopharmacologic agents are helpful as an adjunct to a comprehensive treatment plan. Overdoses of cocaine are treated by diazepam and propranolol. Antidepressant medications, both TCAs and MAOIs, often help relieve the symptoms of depression that emerge when chronic use of cocaine is discontinued. Classical and operant conditioning contribute to craving for the drug and opportunities to extinguish these factors are valuable in preventing relapse. Compulsive users often have an Axis II diagnosis of borderline or narcissistic personality disorder, which require long-term psychodynamic psychotherapy.

Antidepressive Agents↗
PubMed1994

Fatal methemoglobinemia due to inhalation of isobutyl nitrite.

Isobutyl nitrite is a popular recreational drug among both homosexuals and heterosexuals as it is alleged to enhance sexual pleasure and prolong orgasm. In contrast to the ingestion of this volatile nitrite, inhalation is associated only rarely with serious sequelae, though symptomatic methemoglobinemia may occur. The case reported is the first documented fatality from inhalation of isobutyl nitrite. The widespread use of isobutyl nitrite is a cause for concern and physicians should be aware of the potentially fatal consequence of abuse, particularly in those with ischemic heart disease, and its management.

Administration, Inhalation↗