Inhalation of 1-1-difluoroethane: A Rare Cause of Pneumopericardium

Abstract

We report a case of a 32-year-old man with a past medical history of ethanol use disorder who was brought in unresponsive after inhaling six to 10 cans of the computer cleaning product, Dust-Off. After regaining consciousness, he endorsed severe, pleuritic chest and anterior neck pain. Labs were notable for elevated cardiac enzymes, acute kidney injury, and his initial electrocardiogram (ECG) revealed a partial right bundle branch block with a prolonged corrected QT interval (QTc). On chest X-ray as well as chest computed tomography, the patient was found to have pneumomediastinum, pneumopericardium, and subcutaneous emphysema. The patient’s course was uneventful and he was discharged home two days later after extensive substance abuse cessation counseling. Intentionally inhaling toxic substances, also known as “huffing,” is a dangerous new trend with significant consequences that clinicians need to be aware of and suspect in young patients presenting with chest pain. We present a rare case of pneumopericardium induced by inhalation of Dust-Off (1-1-difluoroethane).

1,1-Difluoroethane Detection Time in Blood after Inhalation Abuse Estimated by Monte Carlo PBPK Modeling

“…The Florida State Medical Examiners Commission found that there were 49 statewide deaths caused by inhalants in 2018 of which 83% involved halogenated inhalants, especially DFE [ 24 ]. Reported acute health effects of DFE inhalation in nonfatal cases include auditory and visual hallucinations and delusions [ 25 ], mania with psychosis [ 26 ], disorientation, poor judgement and disinhibition, tremors, ataxia [ 23 ], generalized tonic clonic seizure activity [ 27 ], dyspnea on exertion [ 23 ], pulmonary irritation and cough [ 28 ], frostbite burns of skin [ 20 , 29 ], cutaneous burn injury by hydrofluoric acid from thermal degradation of DFE [ 30 ], cutaneous flame burns from fire ignition of DFE [ 30 ], angioedema [ 31 ], palpitations and irregular pulse, chest pain, pneumopericardium [ 29 ], cardiomyopathy [ 32 , 33 ], toxic myocarditis [ 23 ], nausea and vomiting, acute liver injury and fulminant hepatitis [ 23 , 33 , 34 ], rhabdomyolysis and acute renal failure [ 22 , 33 , 34 ]. Some reported long-term health effects include skeletal fluorosis [ 35 ] and possibly chronic kidney disease [ 22 ].…”

Air Duster Inhalant Abuse Causing Non-ST Elevation Myocardial Infarction

“…We also found multiple reports of huffing abuse causing myocarditis, pneumopericardium, rapid airway compromise, and chemical or thermal burns [1,[5][6][7]. Inhalant abuse should be considered as a differential diagnosis in young patients presenting with elevated cardiac, liver, or possibly renal markers of unknown etiology.…”