Romero Jesus, Abboud Rachel, Elkattawy Sherif, Romero Ana, Elkattawy Omar, Samak Abdel Azez Abu, Shamoon Razan
Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, New Jersey, USA.
Cardiology Department, St. Joseph's University Medical Center, Paterson, New Jersey, USA.
Eur J Case Rep Intern Med. 2022 Sep 26;9(9):003556. doi: 10.12890/2022_003556. eCollection 2022.
The abuse of inhalants has become a public health concern in the USA over the past decade. Compressed air duster cans currently available in the USA contain highly toxic substances including different hydrofluorocarbons (including tetrafluoroethane and difluoroethane) which exert a psychoactive effect on the central nervous system. Several cases of inhalant-induced lethal arrhythmia such as ventricular fibrillation evolving to torsade de pointes and leading to cardiac arrest, have been reported in the literature. Furthermore, multiorgan failure including liver and kidney injury has been described after inhalant abuse. We report the case of a 33-year-old man found diaphoretic and with a near syncopal episode after inhalation of several cans of Surf Onn electronic duster gas cleaner, who subsequently developed acute cardiac, liver and kidney injury.
Although the pathophysiological mechanisms have not been fully elucidated, the hydrofluorocarbons in air duster cans may exert a psychoactive effect through GABA receptor stimulation and NMDA receptor inhibition.Clinicians should maintain a low threshold of suspicion for patients presenting with multiorgan failure, predominantly cardiac arrhythmias after inhalant overdose.Prompt recognition and early intervention are imperative for preventing fatal outcomes such as cardiac arrest secondary to life-threatening cardiac arrhythmias.
在过去十年中，吸入剂滥用已成为美国的一个公共卫生问题。美国目前市面上的压缩空气除尘罐含有剧毒物质，包括不同的氢氟烃（包括四氟乙烷和二氟乙烷），这些物质会对中枢神经系统产生精神活性作用。文献中报道了几例吸入剂诱发的致命性心律失常，如室颤演变为尖端扭转型室速并导致心脏骤停。此外，吸入剂滥用后还出现了包括肝和肾损伤在内的多器官功能衰竭。我们报告了一例33岁男性病例，该患者在吸入几罐Surf Onn电子除尘气体清洁剂后出现多汗和近乎晕厥发作，随后出现急性心脏、肝脏和肾脏损伤。
尽管病理生理机制尚未完全阐明，但空气除尘罐中的氢氟烃可能通过刺激γ-氨基丁酸（GABA）受体和抑制N-甲基-D-天冬氨酸（NMDA）受体发挥精神活性作用。临床医生对出现多器官功能衰竭（主要是吸入剂过量后出现心律失常）的患者应保持较低的怀疑阈值。为预防致命后果，如危及生命的心律失常继发心脏骤停，及时识别和早期干预至关重要。
