Postmortem Diagnosis of Myocardial Infarction Due to Butane Gas Intoxication in a Child

Abstract

Volatile substance addiction and toxic gas inhalation are now an important health problem. The pleasure-based inhalation of butane gas, also known as lighter refill gas, is especially prevalent among children and young people. The most important reasons for this situation are that they are cheap and easy to obtain and lack of legal supervision. The exhaled gas is absorbed through the alveolar surface and rapidly enters the bloodstream and leads to clinical signs. It can cause dizziness, nausea, vomiting, confusion, hallucinations, and euphoria in the acute phase. In severe cases, bronchospasm, hypoxia, ventricular arrhythmia, cardiopulmonary arrest, and death can occur. Our case is one of the rare cases in the literature that was diagnosed by postmortem histopathological examination. Our case is a 15-year-old girl who was found in front of a tobacco product store. On gross examination, there was a hemorrhagic area under the aortic valve that continued to interventricular septum. There was no coronary artery lesion. Histopathological examination revealed hypereosinophilia and contraction band necrosis in myocardial fibers, which was more intense in papillary muscle. Immunohistochemical studies also supported early myocardial ischemic changes. Upon toxicological examination, butane gas was detected in lung and blood samples.

A two‐decade review of butane toxicity as a substance of abuse

“…When investigating suspicious cases of butane exposure and myocardial infarction, specifically in young individuals with sudden death, the toxicity of illicit drugs such as cocaine and amphetamines should strongly be considered. History of harmful use, toxicology tests and conditions of the scene, in which the deceased individual has been found, may be helpful in determining the diagnosis 50 …”

“…History of harmful use, toxicology tests and conditions of the scene, in which the deceased individual has been found, may be helpful in determining the diagnosis. 50 Supportive care is the cornerstone of butane poisoning management. However, the majority of patients may rapidly succumb to death in solitude, and resuscitation is rarely successful.…”

Butane Toxicity: The Curse of Volatile Solvent Abuse

“…Toxicological examination, where no clear history is available, can be used to confirm butane gas in blood and urine samples by means of gas chromatography [5]. How-ever, if there is a long delay in sending blood samples to the appropriate laboratory, butane can still be detected in adipose tissue at autopsy up to 2 weeks after death from suspected butane inhalation [6].…”

A Case Series of Butane Intoxication Fatalities in the Southeastern Anatolia Region of Türkiye

“…After alcohol and cigarettes, VSA is the third most common form of substance abuse. The most frequently used VSA substances in Türkiye are toluene (paint thinner), chloride hydrocarbons (commonly found in solvents and pesticides), and lighter gas fluid (2,3). The incidence of VSA among adolescents and young adults in the U.S. has been estimated to vary between 10 and 15%, with a higher incidence among states with large rural populations (4).…”

“…Its widespread use is primarily due to its low cost, ease of availability, and lack of legislation governing its sale. (2)(3)(4)(5)(6). Deaths resulting from butane intoxication are typically due to i) butane causing direct toxicity and cardiac arrhythmia, such as ventricular tachycardia and fibrillation (8,9); ii) indirect toxicity caused by hypoxemia, anoxia, and vagal inhibition due to oxygen in the airway being used up (10); or iii) trauma associated with high-risk behaviors due to confusion while intoxicated (11).…”