Is it worth carrying out determination of n-butane in postmortem samples? A case report and a comprehensive review of the literature

Abstract

The aim of this article is to illustrate the importance of N-butane determination in postmortem samples through a case report and to propose actions and precautions to be taken into consideration when butane is suspected to be involved in cases of death. The case concerns a 15-year-old boy found dead after sniffing a cigarette lighter refill. Toxicological investigation revealed the presence of butane in the heart and femoral blood (1280 and 1170 μg/L, respectively), in the gastric contents (326 μg/L), and in the liver (1010 μg/kg) and lung tissues (210 μg/kg). Propane was present only in the blood samples at concentrations tenfolds lower.Butane can be involved in three kinds of fatalities: deliberate inhalations including volatile substance abuse (VSA), involuntary exposure, and homicides. A fatal outcome of butane inhalation can be caused by asphyxia and/or cardiac arrhythmia. In the context where butane exposure is evidenced by non-toxicological investigations, the usefulness of the determination of butane in postmortem samples is often questionable. However, it is admitted that butane-related deaths are generally underreported. Several difficulties including sample handling and storage, substantial variation in tissue concentrations, and lack of a lethal threshold make the interpretation of butane results challenging. In our opinion, systematic toxicological methods should be developed in order to analyze butane, at least when it concerns a typical VSA victim, even when butane is not actually suspected to be the cause of death.

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“…Use of a fume hood is mandatory in laboratory settings. Inhalation of traces of butane appears to pose no major health risk, although death reports correlated with butane inhalation have concerned the abuse of gas fuel among drug addicts 37 38 . Supercritical CO 2 extraction is very likely more appropriate for preparing cannabis concentrates.…”

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“…Forensic toxicologists need to identify gaseous components in blood or tissue samples as evidence for suspected volatile gas abuse both in clinical situations and at autopsy [3]. However, this requires preanalytical and analytical precautions with regard to proper sample collection, storage, and handling [3][4][5] as some kinds of gaseous components disappear easily, even at room temperature. The contents of n-butane in blood samples have been shown to decrease by 50% within 3 days when stored at room temperature [6].…”

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“…Autopsy in fatal cases after the inhalation of butane or propane show pulmonary oedema with or without eosinophilia and haemorrhage, abrasion of bronchial or bronchiolar epithelial lining and mucous material in large and small airways and alveoli 11–13. However, in at least one case autopsy revealed no pathologic pulmonary findings 14. Furthermore, animal studies in rats exposed to high concentrations of (iso)butane or propane show no pulmonary toxicity as is the case in humans repeatedly inhaling these propellants and so propane and butane are considered to have a low risk to human health 15.…”