Volatile inhalants such as glue, lighter fluid, spray paint are abused by "sniffing" (from container), "huffing" (poured into rag), or "bagging" (poured into bag). "Dusting" is the abuse of canned air dust removal products. These inexpensive easliy accessible products are so dangerous that manufacturers include product warnings regarding lethal consequences from misuse and even may indicate that a bitterant is added to discourage use. Common duster gases include the halogenated hydrocarbons, 1,1-difluoroethane or 1,1,1-trifluroethane which are highly lipid soluble and rapidly absorbed by alveolar membranes and distributed to CNS. Desired effect of euphoria and disinhibition rapidly occur but unwanted side effects include confusion, tremors, ataxia, pulmonary irritation, asphyxia and, rarely, coma.
"Sudden sniffing death" is seen within minutes to hours of use and is due to ventricular arrhythmias and cardiovascular collapse. Available experimental evidence postulates the following mechanisms: Inhibition of cardiac sodium, calcium, and repolarizing potassium channels hERG and I(Ks) causing reduced conduction velocity and altered refractory period leading to reentry arrythmias or myocardial "sensitiization" to catecholamines resulting in after depolarizations and enhanced automaticity. Treatment should include standard resuscitation measures but refractory arrythmias to defibrillation have been reported and use of amiodarone and beta blockers should be considered.
Bottom Line:
Sudden death involving inhalation of 1, 1-difluoroethane (HFC-152a) with spray cleaner: three case reports. K Sakai, K Maruyama-Maebashi, et.al. Forensic science Int. Volume 206, Issues 1–3, 20 March 2011.
Esmolol in treatment of severe arrhythmia after tricholoroethylene poisoning. Mortiz F. de La Chapelle, et al. Intensive Care Med. 2000 Feb;26(2):256.
Deaths Involving 1,1-Difluoroethane at the San Diego County Medical Examiner's OfficeVance C., Swalwell C., et al. Journal of Analytical Toxicology, Volume 36, Issue 9, November/December 2012.
