Volatile substance misuse deaths in Washington State, 2003–2012

1,1-Difluoroethane Forensic Aspects for the Toxicologist and Pathologist

1,1-Difluoroethane (DFE) is a halogenated hydrocarbon that is commonly used as a propellant in air duster products. Herein, the pharmacology of DFE was reviewed, and questions relevant to medicolegal investigations were addressed. Particular emphasis was given to detection time in biological specimens and the range, onset and duration of effects. DFE may be abused as an inhalant and is rapidly absorbed through the lungs. Onset of central nervous system (CNS) depressant effects is within seconds and the duration may only last minutes. The effects may lead to impairment of human performance, including confusion, lethargy, impaired judgment, loss of motor coordination and loss of consciousness. Death may result even after the first use. With heavy use or in combination with other CNS depressants, extended periods of drowsiness or loss of consciousness may be observed with an increased risk of a fatal event. A majority of impaired driving investigations where DFE was identified included a collision demonstrating the significant impact its use may have on traffic safety. When DFE is identified alone, without other drugs that cause CNS impairment, the effects may not be observable minutes after the crash, making identification of its use difficult. Although concentrations dissipate rapidly, DFE has been detected in blood specimens collected up to 3 hours after the driving incident. Two studies on passive exposure presented herein demonstrated that it is unlikely to detect DFE above concentrations of ∼2.6 µg/mL in blood or urine due to even extreme unintentional exposure. Alternative specimens such as brain, lung and tracheal air should be considered in some postmortem investigations. DFE has been identified in blood specimens from postmortem cases at concentrations from 0.14 to 460 µg/mL and in impaired driving cases from 0.16 to 140 µg/mL.

Computer and electronic duster spray inhalation (huffing) injuries managed at emergency departments

Background: Computer and electronic duster sprays contain halogenated hydrocarbon gases. Intentional inhalation of computer and electronic duster sprays to induce intoxication, also known as huffing, may cause serious adverse effects and even death.Objectives: Describe computer and electronic duster spray inhalation-related injuries managed at United States (US) emergency departments (EDs).Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS), a database of consumer product-related injuries collected from the EDs of approximately 100 hospitals in the US. Cases were computer and electronic duster spray inhalation-related injuries included in NEISS during 2001-2017. The distribution by selected variables was determined for the resulting cases as well as a weighted estimate.Results: A total of 320 computer and electronic duster spray inhalation-related injuries were identified, resulting in a national estimate of 14,715 (95% confidence interval 11,120-18,311) such injuries. The annual estimated number of injuries remained low during 2001-2008 then increased during 2008-2017. Of the estimated injury patients, 3.2% were aged 6-12 years, 20.3% 13-19 years, and 76.5% 20-59 years; 65.4% of the patients were male. The disposition of the patient was 71.4% treated and examined and released, 6.9% treated and transferred, 11.6% treated and admitted or hospitalized, 0.7% held for observation, and 8.7% left without being seen.Conclusion: This study suggests that computer and electronic duster spray inhalation (huffing) may be an increasing issue of which hospital EDs and other clinicians should be aware. The pattern of injuries observed may be useful for targeting education, prevention and management activities.