ABSTRACT
BACKGROUND: Butane gas is inhaled by young people with the aim of getting 'high'. This can cause coronary spasm with myocardial infarction and ventricular fibrillation as a result. CASE DESCRIPTION: We report on a 16-year-old male who collapsed at home after sniffing butane. His father, together with a paramedical emergency team that had found ventricular fibrillation, started basic and advanced life support. ECG showed exaggerated ST-elevations and an echocardiography showed a hypokinetic anterior ventricular wall and ventricular septum. After treatment with dobutamine, nitroglycerine, acetylsalicylic acid and dalteparine, the ECG and left ventricular function improved. He was admitted to a pediatric intensive care unit where he was artificially ventilated for 4 days and treated for cardiogenic shock. In the following days his cardiovascular condition improved. Magnetic resonance imaging showed no ischaemic damage of the brain. At 6 weeks his general condition was not as before, but ECG and cardiac function had almost recovered. CONCLUSION: Young people who experiment with inhalation of volatile substances generally do not know how dangerous this is. Provision of information about the possible consequences will have a preventive effect.
Subject(s)
Butanes/administration & dosage , Butanes/adverse effects , Myocardial Infarction/chemically induced , Administration, Inhalation , Adolescent , Electrocardiography , Humans , Male , Myocardial Infarction/therapy , Respiration, Artificial , Spasm/chemically induced , Spasm/therapy , Substance-Related Disorders , Treatment Outcome , Ventricular Fibrillation/chemically induced , Ventricular Fibrillation/therapyABSTRACT
In this prospective, randomized, open controlled study we compared the effects on net red blood cell loss of 6% hydroxyethyl starch 130/0.4 (HES: n = 64) and 3% modified fluid gelatin (GEL: n = 68) administered for intravascular volume management in patients undergoing coronary surgery. Blood losses were calculated from determination of circulating blood volume and measurement of preoperative and postoperative hematocrit. Amount of colloids that could be administered was limited to 50 mL/kg. If additional fluids were required, balanced crystalloid solution was used. Anesthetic and surgical techniques were standardized. Both groups were similar with regard to demographic and intraoperative variables. Total study drug was 48.9 +/- 17.2 mL/kg in the HES group and 48.9 +/- 14.6 mL/kg in the GEL group. Total red blood cell loss was 544 +/- 305 mL in the HES group and 504 +/- 327 mL the GEL group. Measured blood losses were also similar in both groups (HES, 19.4 +/- 12.3 mL/kg; GEL, 19.2 +/- 14.5 mL/kg). Exposure to allogeneic blood product was comparable in both groups. In the conditions of the present study, HES 130/0.4 up to 50 mL/kg is a valuable alternative to modified fluid gelatin for plasma volume expansion during and after cardiac surgery.
