Sudden death after isobutane sniffing: a report of two forensic cases

  • H. Pfeiffer
  • M. Al Khaddam
  • B. Brinkmann
  • H. Köhler
  • J. Beike
Technical Note

Abstract

The intentional inhalation of a volatile substance (“sniffing”) causing euphoria and hallucinations is an under-recognised form of substance abuse in children and adolescents with a high morbidity and mortality. Sudden death can be caused by cardiac arrhythmia, asphyxia or trauma. Two fatal cases of isobutane sniffing of cigarette lighter refill containing isobutane are reported. Toxicological investigations revealed the presence of isobutane in the heart blood and brain tissue of both cases (case 1: heart blood 0.1 μg/g, brain tissue 2.3 μg/g; case 2: heart blood 4.6 μg/g, brain tissue 17.4 μg/g) and the presence of its metabolite 2-methyl-2-propanol in the heart blood of both cases (0.5 and 1.8 μg/g, respectively). The histological investigations of the inner organs showed similar results in both victims. Autopsy findings, results of the histological and immunohistochemical investigations, toxicological findings and analytical procedures are discussed.

Keywords

Isobutane Inhalant abuse Forensic toxicology Sudden death 

References

  1. 1.
    Adgey AA, Johnston PW, McMechan S (1995) Sudden cardiac death and substance abuse. Resuscitation 29:219–221CrossRefPubMedGoogle Scholar
  2. 2.
    Ago M, Ago K, Ogata M (2002) A fatal case of n-butane poisoning after inhaling anti-perspiration aerosol deodorant. Leg Med 4:113–118CrossRefGoogle Scholar
  3. 3.
    Bass M (1970) Sudden sniffing death. JAMA 212:2075–2079CrossRefPubMedGoogle Scholar
  4. 4.
    Bouche MP, Lambert WE, Van Bocxlaer JF, Piette MH, Leenheer AP (2002) Quantitative determination of n-propane, iso-butane, and n-butane by headspace GC-MS in intoxications by inhalation of lighter fluid. J Anal Toxicol 26:35–42PubMedGoogle Scholar
  5. 5.
    Brinkmann B, Fechner G, Püschel K (1983b) Zur Ultrastrukturpathologie des Alveolarapparates beim experimentellen Ertrinken. Z Rechtsmed 91:47–60CrossRefPubMedGoogle Scholar
  6. 6.
    Fineschi V, Neri M, Riezzo I, Turilazzi E (2004) Sudden cardiac death due to hypersensitivity myocarditis during clozapine treatment. Int J Legal Med 118:307–309CrossRefPubMedGoogle Scholar
  7. 7.
    Flanagan R, Ruprah M, Meredith T, Ramsey J (1990) An introduction to the clinical toxicology of volatile substances. Drug Saf 5:359–383PubMedCrossRefGoogle Scholar
  8. 8.
    Janssen W (1984) Forensic histopathology. Springer, Berlin, Heidelberg, New York, pp 224–233Google Scholar
  9. 9.
    Karger B, Lorin de la Grandmaison G, Bajanowski T, Brinkmann B (2004) Analysis of 155 consecutive forensic exhumations with emphasis on undetected homicides. Int J Legal Med 118:90–94CrossRefPubMedGoogle Scholar
  10. 10.
    Ortmann C, Pfeiffer H, Brinkmann B (2000) A comparative study on the immunohistochemical detection of early myocardial damage. Int J Legal Med 113:215–220CrossRefPubMedGoogle Scholar
  11. 11.
    Park J, Min J-S, Heo S, Lim M-A, Park S-W (2005) Quantification of propane in biological material by head-space GC. Forensic Sci Int 151:165–170CrossRefPubMedGoogle Scholar
  12. 12.
    Pfeiffer H, Weiss FU, Karger B, Aghdassi A, Lerch MM, Brinkmann B (2004) Fatal cerebro-renal oxalosis after appendectomy. Int J Legal Med 118:98–100CrossRefPubMedGoogle Scholar
  13. 13.
    Pfeiffer H, Varchmin-Schultheiss K, Brinkmann B (2005) Sudden death in childhood due to varicella pneumonia—a forensic case report with clinical implications. Int J Legal Med (Epub ahead of print)Google Scholar
  14. 14.
    Rohrig T (1997) Sudden death due to butane inhalation. Am J Forensic Med Pathol 18:299–302CrossRefPubMedGoogle Scholar
  15. 15.
    Römhild W, Logemann E, Schmitt G, Alt A, Krebs K, Bartels H, Pedal I, Schmidt U, Beck N, Krause D (2004) Analyse von Propan/Isobutan/n-Butan in vier Todesfällen. In: Pragst F, Aderjan R (Hrsg) GTFCh—Symposium 2003 Ausgewählte Aspekte der Forensischen Toxikologie. Verlag Dr. Dieter Helm. Heppenheim, 109–122Google Scholar
  16. 16.
    Segal E, Wason S (1990) Sudden death caused by inhalation of butane and propane. N Engl J Med 323:1638PubMedGoogle Scholar
  17. 17.
    Shepherd RT (1989) Mechanism of sudden death associated with volatile substance abuse. Hum Toxicol 8:287–291PubMedGoogle Scholar
  18. 18.
    Sugie H, Sasaki C, Hashimoto C, Takeshita H, Nagai T, Nakamura S, Furukawa M, Nishikawa T, Kurihara K (2004) Three cases of sudden death due to butane or propane gas inhalation: analysis of tissues for gas components. Forensic Sci Int 143:211–214CrossRefPubMedGoogle Scholar
  19. 19.
    Tsukamoto S, Chiba S, Muto T, Ishikawa T, Shimamura M (1985) Study on the metabolism of volatile hydrocarbons in mice—propane, n-butane, and iso-butane. J Toxicol Sci 4:323–332Google Scholar
  20. 20.
    Wehner F, Benz D, Wehner H-D (2002) Tödliche Inhalation von Butan–Propan–Gas. Arch Kriminol 209:165–168Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • H. Pfeiffer
    • 1
  • M. Al Khaddam
    • 1
  • B. Brinkmann
    • 1
  • H. Köhler
    • 1
  • J. Beike
    • 1
  1. 1.Institute of Legal MedicineMunsterGermany

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