Is old stuff back? A fatal case of ethyl chloride sniffing

Reversible Neurotoxicity Due To Excessive Use of Ethyl Chloride

BACKGROUND

Ethyl chloride is commercially available as a DVD/VCR cleaner, and can be found as a gasoline additive and topical anesthetic. There is an emerging trend of recreational huffing to enhance sexual relations. Neurotoxicity from repeated abuse is uncommon.

CASE REPORT

A 36-year-old man with a history of intermittent ethyl chloride use for 15 years presented to the Emergency Department with an inability to walk for 4 days after frequent use for 1 week. The patient reported a rapid titration of inhalation from zero to eight cans of 4.6 oz ethyl chloride aerosol per day over a 1-week period. Initial vital signs were heart rate 88 beats/min, blood pressure 147/60 mm Hg, temperature 37.2°C (99°F), and respiratory rate 16 breaths/min. Physical examination was notable for slurred speech, ptosis, a wide-based and ataxic gait with short strides, inability to stand without support, loss of toe/finger proprioception, horizontal and vertical nystagmus, and dysmetria on coordination testing. Strength and sensation were preserved. His work-up included computed tomography and magnetic resonance imaging of the brain, cervical, thoracic, and lumbar spine that demonstrated no acute abnormalities. On hospital day 9, the patient was able to ambulate with mild difficulty. WHY SHOULD AN EMERGENY PHYSICIAN BE AWARE OF THIS?: Toxicity from excessive ethyl chloride huffing has been rarely reported. The toxicity was characterized with cerebellar findings, no attributable laboratory abnormalities, and no radiographic abnormalities on computed tomography/magnetic resonance imaging. The neurotoxicity resolved with supportive care. This case of excessive huffing of ethyl chloride presenting with neurotoxicity and ataxia further characterizes a rare complication of ethyl chloride toxicity that is gaining popularity.

Two Cases of Fatal Inhalation of Easily Available "Recreational" Substances

ABSTRACT

We present 2 cases of fatal inhalation of easily available highly volatile substances that occurred in a recreational context. Case 1 concerns an 18-year-old man who was found dead with a 25-L plastic bag pulled over his head and a whipped cream steel siphon connected to the bag. The deceased was known to previously have inhaled nitrous oxide. Autopsy results were unremarkable, toxicological analysis using static headspace gas chromatography coupled to mass spectrometry analysis proved the presence of nitrous oxide in lung tissue and blood. Asphyxiation was ascertained as the cause of death. Case 2 describes the death of a 54-year-old man found dead on his bed wearing a rubber gas mask. A bottle with ethyl chloride-containing cold spray was found beside him. Autopsy did not reveal relevant pathological findings; a subsequent toxicological analysis proved the presence of ethyl chloride. Respiratory arrest because of ethyl chloride inhalation was established as the cause of death. The 2 cases presented here demonstrate the danger of easily available, volatile substances with a high potential for abuse. A careful investigation of the death scene, proper specimen collection during the autopsy, and extensive toxicological tests, including headspace gas chromatography coupled to mass spectrometry analysis, are necessary to prove inhalation of these substances.

Inhaling muscle spray: A rising trend of abuse

Ethyl chloride was popular as an inhalant recreational drug in the 1980s. It is easily available in pharmacies as well as sold online as a topical anesthetic spray for pain relief. In recent times, its use is gaining popularity again among the youth as an inhalant drug due to its neuro-stimulatory effects. To avoid the risks associated with use of illegal drugs, and ease of availability of ethyl chloride without restrictions, there is a rising trend to use it as a “substitute” drug of abuse. In this paper, we try to highlight to the critical care and emergency physicians that majority of these cases present with predominant neurological symptoms, with occasional involvement of the cardiovascular system. The diagnosis of ethyl chloride poisoning is primarily clinical and supportive care is the mainstay of treatment, along with subsequent counseling. Ethyl chloride abuse should be considered as a differential diagnosis in young patients presenting with predominant neurological symptoms. Alongside raising public awareness, the manufacturers and retail distributors of these products have an important role to play in reducing the risk of abuse.

Correction to: Is old stuff back? A fatal case of ethyl chloride sniffing

An amendment to this paper has been published and can be accessed via the original article.