Living in a Cloud of Volatiles

Transcription

1 Living in a Cloud of Volatiles D. Anderson Los Angeles County Dept. of Coroner CAT - Pasadena, CA June 2004

2 Substance Abuse in America Common DOA Cocaine Methamphetamine & like Opiates PCP Marijuana Prescription medications Many Others

3 Volatiles Abuse Types of Alcohol Ethanol - Good ole drinking alcohol Probably the most common Methanol - Wood alcohol Isopropanol - Rubbing alcohol Metabolizes to acetone Other types of drinking fluids Acetone: Nail Polish Remover Ethylene Glycol (Anti-freeze) High BP - Not volatile Insoluble Ca oxalate deposits in kidney& brain Propylene Glycol (Simple Green)

4 Inhalants A substance or product that produces a chemical gas or vapor by concentrating and intentionally breathed to create an psychoactive effect. Volatility is a measure of the tendency to vaporize or leave the liquid state

5 Types Aliphatic & Aromatic Hydrocarbons Widely distributed in nature, primarily in natural gas and petroleum. Toluene, benzene, xylene and hexane Halogenated Hydrocarbons Trichloroethylene and the Freons Anesthetic gases Ether, nitrous oxide, chloroform and halothane

6 Common Products Volatile solvents and gas products Model airplane glue, paint thinner, gasoline, and nail polish remover Aerosols Nonstick cooking spray, computer keyboard cleaner and hair spray Anesthetics Nitrous oxide or "laughing gas" and ether Nitrites Amyl, butyl, and isobutyl nitrites Often marketed as "poppers" or room odorizers

7 Location of these Products? General Supplies Cements and glues, correction fluid; magic markers, solvent-based dry erase markers Cleaning Supplies Any product in an aerosol can Aerosol air fresheners and deodorizers; computer air duster Wood Shop Paints, varnishes, stains, paint thinner, contact cement Art Supplies rubber cement; printing inks; spray paints and clear finishes

8 Location of these Products? Auto Degreasers, spray lubricants, "Fix-a-Flat" type products, solvents, Freon, brake fluid; gasoline; lacquers, lacquer, thinners Health and Beauty Nail polish and nail polish remover; hair spray; deodorants Cooking Supplies Cooking spray; whipping cream in aerosol cans; whipping cream cartridges (whippets)

9 Huffing vs. Bagging Huffing Inhalants are abused either by "sniffing" though the nose or inhaling fumes through the open mouth ("huffing") much like a smoker inhales cigarette smoke. Usually the open tube of glue, nail polish, or marker is placed close to the nose and the fumes are inhaled. Bagging People who abuse inhalants may also spray the substance into a plastic or paper bag and huff that way ("bagging") or even place the bag over their entire head.

10 Who s Huffing Now? According to Substance Abuse and Mental Health Services Administration s (SAMHSA) 2002 National Survey on Drug Use and Health (NSHUH) More than 22.8 million Americans reported ever having used an inhalant, and about 180,000 were estimated to need treatment because they were dependent on or abused inhalants (2.6 million were between the ages of 12 and 17)

11 Who s Huffing Now? Gender Girls begin inhalant use far earlier than boys with a mean age of first use at 15.0 years, as compared to 16.3 years for boys. Age Typically: 10 to 15 year olds Atypically: 7 and 8 year olds has been reported. Average Age Initial use is about 12 Chronic abuse is usually seen in older adolescents Adults Dance scene to heighten their experience Aphrodisiac effects

12 What s all the HUFF about? To have fun For excitement For intoxication To be part of the group To shock adults To deal with problems To copy the behavior of adults using alcohol As an alternative to alcohol They are easily available They are cheap to purchase They re legal!!

13 Categories of Huffers Experimenter They try it once or twice then stop by themselves Majority of teenagers fall into this category Social/Situational User Usually done with a group of friends The amount of use varies, depending on what else is going on in their lives. These users often develop other interests and grow out of this practice.

14 Categories of Huffers Dependent/Long-Term User Not common Usually have other major problems in their lives May use inhalants alone, or with other people who use inhalants regularly May feel bad about using, but feel unable to give it up One of their few pleasures

15 General Effects of Inhalants Highly lipid soluble (Large V d ) Cross both alveolar membranes and the blood-brain barrier. Volatiles accumulate in the brain and other fatty tissues in the body Onset almost immediately after inhalation Instant RUSH : Rapid entry into the bloodstream through the lungs. Exposure via the pulmonary route avoids first-pass hepatic metabolism Lasts up to about 30 minutes (unless repeated doses) Elimination Lungs Hepatic: Can produce toxic metabolites CCl 4 CHCl 3, CO 2, & hepato toxic trichloromethyl free radical Benzene Phenol

16 General Effects of Inhalants Initial euphoria and lowering of inhibitions Similar to those when you are drunk Disorientation, blurred vision, dizziness, slurred speech, drowsiness, and some people may even experience hallucinations. Users can also experience nausea, blackouts and sickness. The after-effects include a mild hangover that leaves the user feeling tired and lacking in concentration for about a day.

17 Suspecting a Huffer? Huffer s Spots or Huffers rash Drying and redness around the mouth and nose Suffer severe headaches Nosebleeds Bloodshot eyes or Glazed eyes Unpleasant or Chemical Breath Paint stains on clothes, collection of products Flu-like Symptoms Sneezing, Coughing, Runny nose Long-term effects Brain damage Kidney or Liver failure

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20 What Else Can Happen? Accidental suffocation Plastic bags over their heads to get the full effect from the solvents Risk of choking on their own vomit if they blackout Reckless Behavior Solvent Abusers do reckless or dangerous things after using inhalants DEATH!! - Sudden sniffing death syndrome Irregular heart rate induced by inhalant Cardiac effects: Hypertension, tachycardia, and bradycardia

21 Laboratory Issues

22 Specimen Choice? Ante-mortem Blood Urine: Not going to happen! Post-mortem Blood Lung air or Tracheal gas

23 Stability ETOH Volatiles - Factors Evaporation (large headspace in container) Microbial consumption, chemical oxidation to Acetaldehyde ETOH Glucose ETOH (microorganisms) Vitreous and urine somewhat resistant to Decomp Acetone production Diabetics Inhalants Binding vs. Displacement

24 Analysis Factors Time Temperature Preservation Storage Volatile Analysis Headspace GC/FID-most common Volatile Type

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26 Helium Deaths At least 3 in the last year 85-year old female-plastic bag over head with Helium tank on (Suicide). 56-year old male-plastic bag over head with Helium tank on (Suicide). 79-year old male-plastic bag over head with Helium tank on (Suicide). How in the world do you analyze for Helium?

27 It s Time for some Real Case Studies

28 Case Study #1: So Much for a Good Time! December 30, year old Black Male Found unresponsive and lying in bed by his girlfriend She attempted CPR, transported to Hospital-DOA History of chest pains, ulcer, no abuse of drugs or alcohol. No foul play, no trauma

29 So Much for a Good Time! Autopsy Unremarkable 214 pounds, 68 inches (5 8 ) Healthy 43-year old male Toxicology Comprehensive Drug Screen Volatiles, DOA & Prescription Medications

30 So Much for a Good Time! Toxicology Results Volatiles Heart Blood Amitriptyline 0.53 ug/ml Nortriptyline 0.53 ug/ml Fluoxetine 0.81 ug/ml Norfluoxetine 0.81 ug/ml

31 MEOH/Formaldehyde 1.06 Ethanol 1.62 Acetone Isopropanol T-Butanol (IS) 3.76

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33 Chloroethane Ethylchloride Colorless, flammable gas Ether-like or pungent odor Uses Inhalation anesthetic Refrigerant Local anesthetic for freezing tissues Body piercing Sports injuries Pharmacological effects CNS Depression Cardiac arrhythmias

34 So Much for a Good Time! Questions? Hospital Intervention Artifact Topical Anesthetic? Huffing? No scene visit Investigations cannot locate Girlfriend

35 So Much for a Good Time! March 17, 2004 (2 ½ Months later) Interview the girlfriend Decedent and her went to Mexican Restaurant for Dinner Before having sex, Decedent sprayed Maximum Impact onto a towel and inhaled for more stamina Decedent had erection that night, but never ejaculated Two of them went to bed and he never awoke.

36 So Much for a Good Time! Cause of Death Chloroethane Intoxication Mode of Death Accident

37 Case Study #2: For Adults Only! Scene Investigation (1999) Apparent autoerotic Death 48-year old Caucasian male History of AIDS Last known to be alive 3-4 days prior Found during welfare check-nude on bed Foul play not suspected Multiple medications and sexual paraphernalia recovered Video Head Cleaner cans were recovered

38 For Adults Only! Autopsy Partially Decomposed 183 pounds, 71 inches (5 11 ) Plastic Bag over head with rope ligature around neck Condensation present inside bag Cloth Gag in mouth Cerebral and pulmonary edema No hyoid trauma or fracture Hypertrophic cardiomyopathy Moderate Coronary atherosclerosis

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43 For Adults Only! Toxicology Comprehensive Drug Screen Volatiles, DOA & Prescription Medications

44 For Adults Only! Toxicology Results Alprazolam Buproprion Buproprion Metabolites Heart Blood 69 ng/ml +<0.10 ug/ml Present

45 For Adults Only! Cause of Death Asphyxia Atherosclerotic Heart Disease Chloroethane Effect Mode of Death Accident

46 For Adults Only! Why Solvent Abuse? Enhanced his sexual orgasm while engaged in self gratification Inserting metal and plastic catheters into his penis Leather bondage Piercing of the body

47 Case Study #3: Light Me Up! January 23, year old Hispanic Female Transported to Hospital - DOA Seen inhaling butane with friends Cans of butane were thrown over the fence and later recovered by police

48 Light Me Up! Father s Information Caught daughter abusing Fresh Spray or room freshener/deodorizer 9 months prior He spoke to the principle and told daughter not to associate with one of her female friends Thought she was poor influence Thought she was not inhaling anymore No other alcohol, tobacco, or drug use

49 Light Me Up! Autopsy Y incision present-organ procurement Unremarkable Healthy 13-year old female Toxicology specimens submitted Procurement blood Tracheal Air

50 Light Me Up!

51 Neon Lighter Butane

52 Neon Lighter Butane

53 Ronson Fuel (Butane) Isobutane Butane 2.13 min

54 Light Me Up! Toxicology Femoral Blood Tracheal Air Propane Present Present Butane Present Present

55 Light Me Up! Cause of Death Butane and Propane Toxicity Mode of Death Accident

56 Case Study #4: Death by Mistake! December 30, year old black male s death reported History of asthma Required occasional use of inhaler Active in sports: Football and Basketball Problems in Month of December Sent home from school with fever Eye Pain and Headaches-3 days prior to death

57 Death by Mistake! Investigative history Eyes were red from him rubbing them 2 nd day of headache-administered Motrin On December 30, 2003 Mother made appointment at Kaiser 5-year old brother witnesses decedent grab his chest and fall onto a small plastic inflatable chair.

58 Death by Mistake! Autopsy Unremarkable 125 pounds, 57 inches (4 9 ) Appeared to be healthy 12-year old boy Toxicology Comprehensive Drug Screen Volatiles, DOA & Prescription Medications

59 MEOH/Formaldehyde 1.06 Ethanol 1.62 Acetone Isopropanol T-Butanol (IS) 3.76

60 Death by Mistake! Volatile Confusion?? Came from Hospital Hospital Intervention Artifact? Postmortem Production? 12-year old kid with no known COD Further tests/investigations?

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62 Death by Mistake! More Investigations Needed Huffing? Need to talk to family/parents

63 Death by Mistake! January 27, 2003 New Information Father repairs Ice Machines Freon Tanks in the garage Parents intend to talk to the decedents friends

64 A True Tragic Death! January 28, 2003 Mother calls our office The inflatable chair that the decedent collapsed on Inflated on Christmas with a mixture of Carbon Dioxide and R22 The chair had a slow leak and was deflating. The Decedent was trying to blow up the chair with his mouth and was unintentionally inhaling the Freon gas. Parents bring the two chairs and cylinder tank to the office for testing.

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71 A True Tragic Death! Toxicology DFCM present in cylinder and chairs Cause of Death Effects of Difluorochloromethane Inhalation Mode of Death Accident

72 Two-fer Case History Celebration of an 18-Birthday 3 Cousins inhaling Freon 1 passes out, wakes and finds the tank and 2 others at the bottom of the swimming pool

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