"Sudden sniffing death" after inhalation of domestic lipid-aerosol

Volatile substance abuse

Volatile substance abuse has been reported in the literature over the past 20 years or so, and has apparently increased as countries have become more industrialised. This review attempts to clarify trends in volatile substance abuse, problems associated with this behaviour and possible solutions. Data sources included a Medline Search on volatile substance abuse over the last five years, Commonwealth publications, recent State and Territory inhouse publications, three research monographs from the National Institute on Drug Abuse (NIDA) and an article library from the author's workplace. Some 250 articles and monographs were identified, reviewed and categorised into sections relating to epidemiology (including mortality), physiological effects and responses to the problem. Articles were used for reference where they reflected the most up-to-date information or where they were seen as authoritative statements. While the body of knowledge concerning volatile substance abuse has improved, little progress has been made in finding effective solutions to the problem. The fact that users are typically young and that there is a real risk of sudden death associated with even initial use suggests that continuing research is needed to develop innovative approaches to the problem.

Chronic non-neurological toxicity from volatile substance abuse

1. Most of the evidence for chronic non-neurological toxicity from volatile substance abuse is derived from case reports. 2. Factors important in assessing these reports are the marked variations in exposure conditions and in the composition of the products abused. 3. In a young and otherwise healthy population, any chronic organ toxicity arising from VSA has to be gross in order to become clinically apparent. This may partially explain the relatively low incidence of reporting. 4. Toluene and the chlorinated hydrocarbons 1,1,1-trichloroethane and trichloroethylene can cause permanent damage to the kidney, liver, heart and lung, in certain volatile substance abusers.

Alveolitis after use of a leather impregnation spray

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Serious interaction between cyclosporin A and sulphadimidine

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Deaths from abuse of volatile substances: a national epidemiological study

A survey of the United Kingdom detected 282 deaths from abuse of volatile substances during 1971-83. Deaths appeared to have increased in the most recent years, reaching 80 in 1983. Age at death ranged from 11 to 76 years but most deaths (72%) occurred under 20 years. Ninety five per cent of the subjects were male, and in 1983 deaths from volatile substance abuse accounted for 2% of all deaths in males aged 10-19. All areas of the United Kingdom were affected, the rates being highest in Scotland and urban areas. All social classes were affected, though rates were highest in social class V and the armed forces. The volatile substances abused were gas fuels (24%), mainly butane; aerosol sprays (17%); solvents in glues (27%); and other volatile substances, such as cleaning agents (31%). In 51% of cases death was attributed to the direct toxic effects of the substance abused, in 21% to plastic bag asphyxia, in 18% to inhalation of stomach contents, and in 11% to trauma. Deaths associated with the abuse of glues were more likely to be traumatic, but all substances appeared capable of killing directly by their toxic effects, probably by a cardiac mechanism. Only a small proportion of deaths (6%) were due to the abuse of glues among children under 16; hence current attempts to limit access of children to glues will probably have little impact on overall mortality.

An investigation of 140 deaths associated with volatile substance abuse in the United Kingdom (1971-1981)

1 In the UK, from 1971 to 81, 140 deaths associated with volatile substance abuse (VSA) were identified from press reports and a variety of other sources. Data about each death were obtained from inquest proceedings, post-mortem and toxicological reports, and death certificates. 2 Based on the year 1981, in which 39 deaths occurred, VSA deaths accounted for over 1% of deaths from all causes, and nearly 2% of deaths from injury and poisoning in males aged 10-19 years. 3 The median age was 16.8 years (range 11-63), and 79% were under age 20. The male to female ratio was 13:1. 4 Death rates were highest in conurbations, and in Scotland, Northern Ireland and Northern England. Deaths tended to be more frequent among manual social classes but this association was not marked. 5 The chief substances were butane (28%), solvents in adhesives (23%), other solvents (26%), aerosols (15%) and fire extinguishing agent (5%). Solvents in adhesives were more important with increasing age. 6 Most deaths occurred alone, at home. In about 41% of cases, death appeared to be only indirectly associated with VSA (trauma 8%, plastic bag over head 19%, and inhalation of stomach contents 14%). In 49% death was attributed to the direct toxic effects of the substance; this proportion was highest with aerosols and lowest with solvents in adhesives. 7 The implications of these findings for prevention, monitoring and research are discussed.