Death due to acute tetrachloroethylene intoxication in a chronic abuser.

Volatile substances are used widespread, especially among young people, as a cheap and easily accessible drug. Tetrachloroethylene is one of the solvents exerting effects on the central nervous system with experiences of disinhibition and euphoria. The case presented is that of a 27-year-old female, found dead by her father at home with cotton swabs dipped in the nostrils. She was already known for this type of abuse and previously admitted twice to the hospital for nonfatal acute poisonings. The swabs were still soaked in tetrachloroethylene. Toxicological and histological investigations demonstrated the presence of an overlap between chronic intake of the substance (with high concentrations in sites of accumulation, e.g., the adipose tissue, and contemporary tissue damage, as histologically highlighted) and acute intoxication as final cause of death, with a concentration of 158 mg/L in cardiac blood and 4915 mg/kg in the adipose tissue. No other drugs or medicines were detected in body fluids or tissues, and to our knowledge, this is the highest concentration ever detected in forensic cases. This peculiar case confirms the toxicity of this substance and focuses on the importance of complete histological and toxicological investigations in the distinction between chronic abuse and acute intoxication.

Twenty-five years of volatile substance abuse mortality: a national mortality surveillance programme.

AIMS: To investigate trends in volatile substance abuse (VSA) deaths over 25 years. DESIGN: A national mortality surveillance programme with standardised data collection procedures. SETTING: The UK and islands. PARTICIPANTS/MEASUREMENTS: All VSA deaths, 1983-2007. FINDINGS: In the five quinquennia from 1983 to 2007 the numbers of VSA deaths were 499, 609, 378, 349 and 258 respectively. There were gradual increases in the mean age at death in males and females and in the number of VSA deaths in women. Coincident with the 1992 Department of Health Advertising Campaign, VSA deaths in boys and girls (<18 years of age) fell by an estimated 56% (95% CI: 36%-70%) and 64% (20%-84%), respectively, from the underlying trend, but there was no evidence of any similar step change in either group following the 1999 Legislation prohibiting sales of cigarette lighter refills containing butane to those under the age of 18 years. Between 1983-1987 and 2003-2007, the ratio of aerosol to gas fuel deaths fell by an estimated 80% (57% to 91%) in adults, while the ratio of glue to gas fuel deaths fell by an estimated 95% (89% to 97%) in adults and an estimated 87% (-1% to 98%) in children. CONCLUSIONS: Between 1983 and 2007, in the United Kingdom, the numbers of deaths associated with volatile substance abuse peaked in the early 1990s and fell to their lowest level in the mid-2000s. The age at death increased in both males and females. There was a fall in the proportion of volatile substance abuse deaths involving glues and a rise, particularly in adults, in the proportion involving gas fuels.

Deaths involving 1,1-difluoroethane at the San Diego County Medical Examiner's Office.

Intentional abuse of 1,1-difluoroethane has been reported to cause transient symptoms such as confusion, tremors, pulmonary irritation, loss of consciousness and, rarely, coma. In the last five years, 17 cases from the San Diego County Medical Examiner's Office showed the presence of 1,1-difluoroethane in postmortem tissues, and the gas was cited in the cause of death in 13 of those cases. Detected during routine ethanol screening, 1,1-difluoroethane was evaluated for concentrations in peripheral blood, central blood and vitreous humor by a slightly modified method published by Avella et al. In many cases, death from abuse of 1,1-difluoroethane seemed to occur within minutes of intentional abuse; large concentrations (>100 mg/L) of the gas were still in the blood. It is important that forensic toxicology laboratories have routine screening procedures to detect 1,1-difluoroethane because cases exist in which evidence of use from cans may not be present in proximity to the decedent, or may be undiscovered in the debris of a motor vehicle accident. It is also important to quantify concentrations of 1,1-difluoroethane in both peripheral blood and central blood, whose ratio may be useful in interpreting how recently the use of the 1,1-difluoroethane occurred.

Two serious and challenging medical complications associated with volatile substance misuse: sudden sniffing death and fetal solvent syndrome.

Volatile substance misuse is a prevalent and often overlooked behavior among adolescents, including reported use among young pregnant women. Several medical repercussions can arise from the improper use of volatile substances, yet they are often underappreciated among scientists and health professionals. This brief review reports on the recent advances made in the preclinical and clinical data about two serious medical complications surrounding volatile substance misuse: sudden sniffing death and fetal solvent syndrome. Suggestions for treatment interventions are discussed. The paper's limitations are noted.

Meeting professionals' needs in the United Kingdom for effective VSM intervention.

An exploratory study examined what professionals needed to support their responses to volatile substance misuse (VSM). Many respondents saw VSM as a problem of unknown dimensions and were uncertain about how to tackle it. Resources for treatment and prevention were seen as outdated. Workers were concerned that VSM was becoming more common among adults, supporting an indication found in a study of VSM-related deaths. Evidence-informed treatment protocols, information on working with clients, assessments of local needs, and the evaluation of existing approaches to VSM would improve the response. A further phase of the research will be reported in 2012.