HWN Suggests

"Sudden Sniffing Death"

The common theory behind the syndrome is cardiac sensitization that increases susceptibility of the heart to systemic catecholamines (epinephrine, norepinephrine, etc). Usually, it occurs after an episode of exertion in that any excess catecholamine exposure causes irritability of the myocardium, resulting in dysrhythmias (V. fib, V. tach) and cardiac arrest. If acute dysrhythmias is due to myocardial sensitization, sympathomimectics should be avoided. Beta-adrenergic antagonist can be used for the catecholamine-sensitized heart.

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 Huffing Away – Toxicology Blog

As most effects of hydrocarbons last only minutes, treatment is primarily supportive. .. Cardiac arrest secondary to hydrocarbon use is managed differently from standard ACLS. Remember, the myocardium has been sensitized to catecholamines, so doses of epinephrine should be avoided as it could further precipitate the arrhythmia. Consider lidocaine (1-1.5mg/kg first dose, 0.5-0.75mg/kg second dose) in place of epinephrine.

 Inhalant Abuse

From “bagging” refrigerants to sniffing glue, understanding the toxicities and treatments for inhalant overdoses.

Articles of Interest

ACMT Toxicology Visual Pearls: I’ll Huff and I’ll Puff…

Dust Off is an aerosolized computer duster commonly abused as an inhalant, a practice known as “dusting”. It contains the fluorinated hydrocarbon 1,1-difluoroethane (DFE). Hydrocarbon inhalation abuse is associated with “sudden sniffing death” which is manifested by tachydysrhythmias, frequently precipitated by a catecholamine surge. DFE is increasingly cited as a cause of death in recreational inhalant abuse. QTc prolongation and tachycardia are frequently seen

Beta-Blockers for Inhalant-Induced Ventricular Dysrhythmias

There are a few unique scenarios when beta-blockers may be indicated for patients in cardiac arrest. Use of esmolol for refractory ventricular fibrillation was summarized in a 2016 PharmERToxGuy post ... Another potential use for beta-blockers is in the rare case of a patient with inhalant-induced ventricular dysrhythmias. The term ‘sudden sniffing death’ refers to acute cardiotoxicity associated with inhaling hydrocarbons.

Huffing Hydrocarbons: Inhalant Abuse

Don’t just keep shocking! Consider Esmolol for resistant tachydysrhythmias!

Rare but relevant: Hydrocarbons and sudden sniffing syndrome

The use of β-adrenergic blockers has been suggested as a potential therapeutic intervention for managing arrhythmias associated with hydrocarbon inhalation, particularly in resistant ventricular fibrillation. However, the autonomic response triggered by the fight or flight reaction during hydrocarbon exposure is likely to be a transient catecholamine surge that is unlikely to result in sustained adrenergic effects, in contrast to the prolonged sympathomimetic effects seen in cases with substances such as amphetamines. Current advanced life support (ALS) guidelines advocate for established resuscitation protocols focusing on immediate defibrillation and antiarrhythmic medications like lignocaine and amiodarone rather than β-blockade.

Sudden Sniffing Death Syndrome

The use of inhalants dates back to the 19th century when nitrous oxide was introduced as an intoxicant. Nitrous oxide was recognized for its euphoric mental and physical effects on those who inhaled it. This led to recreational use within upper-class society and later contributed to the development of modern anesthetics. Unfortunately, this substance soon proved to be both addictive and dangerous. In the 1950s, inhalant abuse became widespread among teens and youth, leading to troubling consequences for those taking part in it, including sudden sniffing death syndrome.