May 2021

This is a list of the latest papers we are aware of this month relating to the inhalation of gases and solvents. For information specifically on harms relating to butane, please click here.

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Global emissions of VOCs from compressed aerosol products

“... in the UK, 6.1% of anthropogenic VOC emissions were from aerosols in 2017, more than were released from gasoline passenger cars. Should low- and middle-income economies grow consumption per capita in line with recent trends, then we project global aerosol consumption may reach approximately 4.4 ± 0.96 × 1010 units year–1 in 2050. Should existing national and international policies on aerosol product formulation remain unchanged, and VOCs remain the dominant propellant, compressed aerosols could account for a global emission of approximately 2.2 ± 0.48 Tg year–1 in 2050.” 

“… for very many personal care and household cleaning products, a clear solution would be product de-aerosolization.”

Yeoman A.M, Lewis, A.C. (2021) Global emissions of VOCs from compressed aerosol products. Elementa: Science of the Anthropocene. 9(1). DOI: 10.1525/elementa.2020.20.00177.

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Life-threatening oedema triggered by inhalation of nitrous oxide

"In this case report we describe a life-threatening oedema in a 20-year-old woman triggered by inhalation of nitrous oxide. On admission, flexible rhinolaryngoscopy revealed a rapidly progressing oedema of the epiglottis and arytenoid region. The patient was immediately intubated and transferred to the intensive care unit. Due to progression of the oedema a surgical tracheostomy was performed. On day six the canula was removed, and the patient could be discharged in good condition."

Thorsberger M, Aanæs K. (2021). Life-threatening oedema triggered by inhalation of nitrous oxide. Ugeskrift for Laeger, 183(19). PMID: 33998456.

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Recreational Nitrous Oxide and Pernicious Anemia-Associated Vitamin B12 Deficiency in a Patient Presenting with Sensorimotor Polyneuropathy

"On the basis of this evaluation, the working diagnosis was vitamin B12 deficiency due to inhaled nitrous oxide and pernicious anemia presenting with sensorimotor polyneuropathy."

Smith C.M., McCann P., Slauer R., Gilbert E.B. (2021). Recreational Nitrous Oxide and Pernicious Anemia-Associated Vitamin B12 Deficiency in a Patient Presenting With Sensorimotor Polyneuropathy. Prim Care Companion CNS Disord. 11;23(2). DOI: 10.4088/PCC.20l02751.

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Thromboembolisms due to recreational use of nitrous oxide

"In conclusion, we contest the safety and innocence of recreational N2O (ab)use. Our three cases illustrate that, next to previously described neurological complications, the use of nitrous oxide is associated with thromboembolic cardiovascular complications, presumably mediated by hyperhomocysteinemia."

Oomens T., Fokkema T.M.M., van den Bogaard B., de Metz J., van Nieuwenhuizen R.C., Riezebos R.K., Kuipers R.S. (2021). Thromboembolisms due to recreational use of nitrous oxide. Ned Tijdschr Geneeskd. Apr;165 . PMID: 33914433.

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Acute neurological consequences of novel psychoactive substance use: a retrospective review in a large UK hospital

Tanti et al identified 332 admissions with 237 admissions from 190 patients meeting the inclusion/exclusion criteria. "There were four admissions due to NOS; two used NOS with methylenedioxymethamphetamine (MDMA) and cocaine, one presented with psychosis and the other with seizure. All were

conservatively managed."

Tanti M., Cosgrove J., Kelleher C., Jones R., Maguire M. (2021). Acute neurological consequences of novel psychoactive substance use: a retrospective review in a large UK hospital. Clinical Medicine, 21(3), pp189-94. DOI 10.7861/clinmed.2020-0706. 

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Huffing and twist: Fatal Torsade de pointes associated with Tetrafluoroethane Inhalation and amphetamine use

"A patient presented with torsade de pointes after inhaling tetrafluoroethane, a volatile gas propellant used to clean keyboards. She had a prior hospitalization for cardiac arrest without rhythm documentation after inhaling a similar product. Urine toxicology revealed methamphetamine. We are unaware of previous descriptions of torsade de pointes associated with volatile hydrocarbon inhalation or “huffing.” Although sudden death is associated with “huffing,” an arrhythmic mechanism has not been elucidated. Tetrafluoroethane, however, is chemically similar to chloroform (trichloromethane), which blocks the delayed rectifier potassium ion current (Ikr). Thus, we postulate that delayed repolarization with methamphetamine triggering may account for this arrhythmia."

Burke J., Haigney M.C.P., Farasat M., Mehler P.S., Krantz, M.J. (2020). Huffing and twist: Fatal Torsade de pointes associated with Tetrafluoroethane Inhalation and amphetamine use. Wiley Clinical Case Reports. DOI: 10.1002/ccr3.3838.