Subject(s)
Air Pollutants, Occupational/poisoning , Asphyxia/chemically induced , Chlorofluorocarbons, Methane/poisoning , Adult , Fatal Outcome , Humans , Male , Maximum Allowable Concentration , United States , United States Occupational Safety and Health Administration , Ventilation/standards , Young AdultABSTRACT
The Office of the Chief Medical Examiner of Maryland recorded a total of 149 drug abuse deaths of teenagers aged 13-19 years between 1991 and 2006. Of these deaths, 96 (64.4%) were caused by the use of narcotic drugs only, 29 (19.5%) by both narcotics and cocaine, four (2.7%) by both narcotics and methylenedioxymethamphetamine, six (4.0%) by cocaine only, and 14 (9.4%) by volatile substances (e.g., butane, Freon, nitrous oxide, and propane). The annual death rate from drug abuse for teenagers increased from 1.4 deaths per 100,000 population in 1991 to 2.7 deaths per 100,000 population in 2006 (chi-square test for time trend, p<0.01). The increase in teenager drug abuse deaths occurred in 1999 and since has remained at a higher rate. Further analysis revealed that the increase in drug abuse deaths was attributable to a large degree to narcotic drugs, particularly heroin/morphine and methadone, and was confined to teenagers residing in the suburban and rural areas.
Subject(s)
Cause of Death/trends , Substance-Related Disorders/mortality , Adolescent , Age Distribution , Black People/statistics & numerical data , Butanes/poisoning , Chlorofluorocarbons, Methane/poisoning , Cocaine/poisoning , Female , Forensic Pathology , Forensic Toxicology , HIV Antibodies/blood , Hepatitis B Antibodies/blood , Heroin/poisoning , Humans , Male , Maryland/epidemiology , Methadone/poisoning , Morphine/poisoning , Myocarditis/epidemiology , Myocarditis/pathology , N-Methyl-3,4-methylenedioxyamphetamine/poisoning , Narcotics/poisoning , Nitrous Oxide/poisoning , Pneumonia/epidemiology , Pneumonia/pathology , Propane/poisoning , Retrospective Studies , Sex Distribution , White People/statistics & numerical dataABSTRACT
INTRODUCTION: Freons generally have a low order of toxicity, but exposure to relatively high concentrations (>100 ppm) may produce adverse effects on health. Currently, intoxication reports are unintentional inhalation of CFCs. We report an unintentional ingestion of a mixture of CFCs and the results of a rat study. CASE REPORT: A 43-year-old man was admitted to the Emergency Department with a chief complaint of acute abdominal pain that developed minutes after he ingested a clear liquid in a water glass, which contained a mixture of Freon and water. Subsequent surgical evaluation revealed perforation of the stomach and necrosis of the stomach wall. He developed a transient rise in his hepatic transaminases, which resolved spontaneously, and fully recovered from his surgery. METHODS: A murine model of the injury was created to evaluate threshold concentration and effect of time on injury grade. RESULTS: Injury grade increased with delay to histologic analysis from 8 to 24 hours after exposure to Freon. Increasing amounts of Freon also increased the lesion grade score. CONCLUSIONS: Patients ingesting Freon need to be closely evaluated for risk of gastric damage and perforation.
Subject(s)
Accidents , Chlorofluorocarbons, Methane/poisoning , Stomach Rupture/chemically induced , Administration, Oral , Adult , Animals , Chlorofluorocarbons, Methane/pharmacology , Disease Models, Animal , Dose-Response Relationship, Drug , Humans , Male , Necrosis , Rats , Stomach Rupture/pathology , Stomach Rupture/surgery , Time Factors , Treatment OutcomeABSTRACT
A case of accidental Freon 22 (monochlorodifluoromethane) poisoning in a fishing vessel is reported. Forensic autopsy revealed severe pulmonary edema and congestion (left lung; 576 g, right lung; 740 g). GC-MS analysis clearly showed that the deceased inhaled Freon 22 gas prior to his death. Freon 22 concentration was 169+/-7.0 microg/ml in the heart blood. The distribution pattern of Freon 22 in tissue samples was similar to that in previously reported cases. The brain had the highest concentration of Freon 22 followed by the spleen, liver, kidney and lung, respectively. Histopathologically, Oil red O staining of the liver showed many small, positive red areas in the cytosol, which have been reported in other cases of Freon 22 poisoning. However, Schmorl staining revealed that most areas of Oil red O positivity were lipofuscin granules. Lipofuscin in the liver, which closely relates to aging and other cell stresses, could have a relevance to Freon 22 exposure, but further experimental studies are needed to confirm it.
Subject(s)
Accidents, Occupational , Chlorofluorocarbons, Methane/poisoning , Inhalation Exposure , Occupational Exposure , Adult , Brain/metabolism , Chlorofluorocarbons, Methane/metabolism , Fatal Outcome , Forensic Toxicology/methods , Humans , Kidney/metabolism , Liver/metabolism , Lung/metabolism , Male , Ships , Spleen/metabolismABSTRACT
We report 43 cases of chlorodifluoromethane (Freon-22) intoxication that occurred on August 5, 2003 when a freezer in a seafood factory exploded. In this accident, 80 workers were exposed to Freon-22 gas and 43 workers developed symptoms and were transferred to six hospitals. Neurological symptoms including dizziness, headache, and nausea were most frequently observed (40 of 43 patients). One patient was comatose but recovered within 1 h with oxygen inhalation. Airway and respiratory symptoms including dysesthesia of the tongue, pharyngitis, and shortness of breath were also frequently observed (26 of 43 patients). These symptoms disappeared within a few days in all patients. There were no fatalities. Although Freon-22 has been considered to be a chlorofluorocarbon of relatively low toxicity, this incident suggests that potentially significant toxic effects may occur following large exposures.
Subject(s)
Accidents, Occupational , Chlorofluorocarbons, Methane/poisoning , Adult , Coma/chemically induced , Coma/therapy , Female , Food Industry , Humans , Inhalation Exposure , Liver Function Tests , Male , Neurotoxicity Syndromes/physiopathology , Neurotoxicity Syndromes/psychology , Occupational Exposure , Respiratory Tract Diseases/chemically induced , Respiratory Tract Diseases/physiopathology , Retrospective StudiesABSTRACT
Although the neurological and cardiovascular effects of Freons have been extensively described, the respiratory effects have been less well documented. We report four cases of occupational asthma following accidental exposure to bromochlorodifluoromethane (Halon 1211) due to release of the contents of a fire extinguisher. All subjects developed an irritative reaction of the upper airways and lower respiratory symptoms immediately after exposure. Non-specific bronchial hyperreactivity was present for at least two months in all subjects and was still present more than two years after exposure in one case. The diagnosis of reactive airways dysfunction syndrome can be adopted in at least three of these four cases.
Subject(s)
Asthma/chemically induced , Chlorofluorocarbons, Methane/poisoning , Fire Extinguishing Systems , Flame Retardants/poisoning , Occupational Diseases/chemically induced , Adult , Aerospace Medicine , Bromochlorofluorocarbons , Bronchial Hyperreactivity/chemically induced , Female , Humans , Male , Occupational Exposure/adverse effects , SyndromeABSTRACT
A gas chromatographic method with mass spectrometry has been developed for the determination of bromochlorodifluoromethane (Halon 1211) in biological material (whole blood, organ samples). After incubation of the sample (temp. 65 degrees C, 15 min), 10 microliters of the headspace is analysed using a capillary column DB-5 ms (30 m x 0.25 mm x 0.25 micron). Quantitative analysis was made with the use of a single ion monitoring option--m/z 85 and m/z 87. This developed method was used to determine the concentration of bromochlorodifluoromethane in biological material collected from the body of the man whose death was due to intoxication of Halon 1211--fire-extinguisher contents.
Subject(s)
Chlorofluorocarbons, Methane/poisoning , Flame Retardants/poisoning , Gas Chromatography-Mass Spectrometry , Substance Abuse Detection , Adult , Autopsy , Bromochlorofluorocarbons , Evaluation Studies as Topic , Forensic Medicine/methods , Gas Chromatography-Mass Spectrometry/methods , Humans , Male , Reproducibility of Results , Sensitivity and Specificity , Substance Abuse Detection/methodsABSTRACT
The authors analyze 62 expert conclusions on deaths from acute and chronic poisoning with various toxic substances used by toxicomaniacs. Forensic medical examination of corpses and forensic chemical analysis identified drugs, toluene, freon, organophosphorus compounds, and other toxins.
Subject(s)
Chlorofluorocarbons, Methane/poisoning , Organophosphate Poisoning , Substance-Related Disorders/diagnosis , Toluene/poisoning , Adolescent , Adult , Cause of Death , Diagnosis, Differential , Humans , Substance-Related Disorders/etiologySubject(s)
Chlorofluorocarbons, Methane/poisoning , Illicit Drugs/poisoning , Inhalation Exposure/adverse effects , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/therapy , Bromochlorofluorocarbons , Fatal Outcome , Fire Extinguishing Systems , Frostbite/chemically induced , Humans , Male , Poisoning/therapyABSTRACT
Two cases of lethal poisoning due to chlorodifluoromethane (Freon 22) inhalation are described. The fluorocarbon was determined in biological tissues by headspace gas chromatography/mass spectrometry. Ions monitored were m/z 67, 86 and 51, the latter being used for quantification. Blood concentrations were 26.0 and 37.1 microliters/ml. In both cases, the drug was also identified in urine, vitreous humor and bile, but in much lower concentrations.
Subject(s)
Chlorofluorocarbons, Methane/poisoning , Accidents, Occupational , Chlorofluorocarbons, Methane/pharmacokinetics , Forensic Medicine , Gas Chromatography-Mass Spectrometry , Humans , Male , Poisoning/pathologyABSTRACT
Phosgene is a highly toxic gas to which some workers may be occupationally exposed. This case report demonstrates the possibility of refrigeration workers suffering phosgene poisoning after heating certain chlorinated fluorocarbons ('freons'). The need to suspect phosgene exposure and observe such patients is emphasized, especially in view of the delay in clinical deterioration observed in some patients who subsequently develop adult respiratory distress syndrome.
Subject(s)
Chlorofluorocarbons, Methane/poisoning , Occupational Exposure/adverse effects , Phosgene/poisoning , Respiratory Insufficiency/chemically induced , Adult , Blood Gas Analysis , Electrocardiography , Humans , Male , Prognosis , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/physiopathologyABSTRACT
Two cases of atrial fibrillation and one case of sudden death occurred in workers exposed to trifluorotrichloroethane (CFC 113) as a solvent/degreasing agent. This agent and related halogenated hydrocarbons are widely used in industry as solvents and degreasing agents, and have been previously linked to ventricular arrhythmias and cardiac sudden death when inhaled in excessive concentrations. We suggest that occupational overexposure to halogenated hydrocarbons should be considered a potential precipitant for atrial as well as ventricular arrhythmias.
Subject(s)
Atrial Fibrillation/chemically induced , Chlorofluorocarbons, Methane/poisoning , Death, Sudden, Cardiac/etiology , Occupational Exposure , Solvents/poisoning , Adult , Chlorofluorocarbons, Ethane , Fatal Outcome , Humans , MaleABSTRACT
A case of lethal poisoning due to trichlorofluoromethane (FC11) inhalation is described. The fluorocarbon was determined in biological tissues by headspace gas chromatography-mass spectrometry. FC11 was detected in all the examined tissues, with decreasing levels in heart, lung, brain, liver, blood, kidney, and spleen. The highest concentration measured in heart could be related to the mode of toxic action of fluorocarbons postulated by many authors, characterized by the sensitization of the myocardium to the catecholamines producing arrhythmia and cardiac arrest. Nevertheless the aspecific picture of the anatomo-pathological and histological findings does not exclude that the described accidental fatality may have been caused by the combination of direct from toxicity with hypoxemic asphyxiation, due to the saturation of the atmosphere by FC11 in the closed environment in which the intoxication occurred.
Subject(s)
Chlorofluorocarbons, Methane/poisoning , Adult , Chlorofluorocarbons, Methane/pharmacokinetics , Chromatography, Gas , Fatal Outcome , Humans , Male , Mass Spectrometry , Occupational Exposure , Tissue DistributionABSTRACT
Presented is a case of successful resuscitation of cardiopulmonary arrest following inhalation of a fluorinated hydrocarbon. Fluorinated hydrocarbons have a direct cardiotoxic effect. We found no previous reports describing resuscitation with good neurologic outcome of a patient in cardiopulmonary arrest subsequent to inhalation of a fluorinated hydrocarbon. Early bystander cardiopulmonary resuscitation and ACLS provider intervention help to contribute to improved patient survival. We present a case illustrating the utility of basic life support and early advanced life support, followed by a review of the pertinent literature.
Subject(s)
Cardiopulmonary Resuscitation , Chlorofluorocarbons, Methane/poisoning , Heart Arrest/therapy , Adolescent , Electric Countershock , Female , Heart Arrest/chemically induced , HumansABSTRACT
Reports on fatalities of chlorofluorocarbons usually involve chlorotrifluoroethane, trichlorofluoromethane, dichlorodifluoromethane or chlorodifluoromethane, where analysis was done using packed column gas chromatography. In this case a death was caused by an azeotropic mixture of chlorodifluoromethane and chloropentafluoroethane, a combination that has not previously been reported in the forensic literature. This report details the analysis using mass selective detection employing capillary gas chromatography columns currently used in many toxicology laboratories. Postmortem toxicology revealed blood concentrations of chlorodifluoromethane and chloropentafluoroethane of 71 mg/L and 0.30 mg/L, respectively. Brain, liver, and lung concentrations of chlorodifluoromethane were (mg/kg) 2.8, 4.4, and 1.6, respectively. Brain, liver, and lung concentrations of chloropentafluoroethane were (mg/kg) 0.80, 0.80, and 0.11, respectively. The victim's blood contained 5.5 mg/L caffeine. Lidocaine, used in resuscitation attempts, was also present in the victim's blood. No other alkali-extractable drugs or volatile alcohols were detected in the victim's blood. The cause of death was acute respiratory arrest due to chlorofluorocarbon inhalation.
Subject(s)
Chlorofluorocarbons, Methane/poisoning , Substance-Related Disorders , Adult , Chlorofluorocarbons, Methane/analysis , Chromatography, Gas , Forensic Medicine , Humans , Male , Poisoning/etiology , Poisoning/metabolism , Poisoning/pathology , Substance-Related Disorders/metabolism , Tissue DistributionABSTRACT
An accidental discharge of a Halon 1301 system is reported. Thirty-one workers were assessed, 22 who were present at the time of the discharge, and 9 who worked the next shift. The incident was complicated by a small Freon-22 leak several hours later. Throat, eye, and nasal irritation and lightheadedness were reported by the majority of workers. Workers present during the halon discharge reported significantly more lightheadedness, headache, voice change, cough, and a fast heartbeat than did those who worked the later shift. These differences were significant even after correcting for confounding factors such as age, sex, and sense of anxiety at the time of the incident. The possible causes for the irritant symptoms include breakdown products of Halon 1301 and Freon-22 or contaminants from the halon discharge system. Although these irritant effects may not be an effect of Halon 1301 alone, they may occur in these discharge situations, and workers should be advised of this possibility. The possible cardiac and central nervous system effects also should be considered. The importance of a clear-cut protocol to deal with such incidents as well as worker education are discussed.
Subject(s)
Chlorofluorocarbons, Methane/poisoning , Flame Retardants , Occupational Diseases/chemically induced , Occupational Exposure , Adult , Attitude to Health , Bromochlorofluorocarbons , Female , Humans , MaleABSTRACT
Bromochlorodifluoromethane (Halon 1211) is a widely used fire extinguishing agent. Several cases of sudden death in teenagers associated with BCF abuse have been reported. BCF is used as a fire extinguisher in battle tanks. Two young previously healthy male soldiers were accidentally exposed to BCF in a battle tank. The tank driver died, but the gunner survived the event with no medial complications. It is concluded that BCF should be used in confined chambers only after the evacuation of all personnel.