Treatment of Acute Intoxication from Inhaled 1,2-Difluoroethane

Letters4 December 2018Treatment of Acute Intoxication From Inhaled 1,2-DifluoroethaneJuan Pablo Arroyo, MD, PhD, Daniel C. Johnson, PharmD, Julia B. Lewis, MD, Ahmed Al Sheyyab, MB BS, Adam King, MD, Matthew R. Danter, MD, Stuart McGrane, MB, ChB, and Joshua P. Fessel, MD, PhDJuan Pablo Arroyo, MD, PhDVanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Search for more papers by this author, Daniel C. Johnson, PharmDVanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Search for more papers by this author, Julia B. Lewis, MDVanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Search for more papers by this author, Ahmed Al Sheyyab, MB BSVanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Search for more papers by this author, Adam King, MDVanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Search for more papers by this author, Matthew R. Danter, MDVanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Search for more papers by this author, Stuart McGrane, MB, ChBVanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Search for more papers by this author, and Joshua P. Fessel, MD, PhDVanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0186 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Difluoroethanes are used as refrigerants, foam-blowing agents, solvents, and propellants in various household products. Volatile substances, such as 1,2-difluoroethane, are inhaled for recreational purposes (known as huffing) because they are intoxicating, inexpensive, and easily acquired. When 1,2-difluoroethane is inhaled, it is metabolized to fluoroacetate. This compound complexes with coenzyme A and is metabolized by citrate synthase to form fluorocitrate, which then binds aconitase, blocks the citric acid cycle, and halts energy production (1). Fluorocitrate accumulation in multiple tissues can lead to hypocalcemia. The clinical presentation of 1,2-difluoroethane intoxication varies depending on the dose and the time since exposure. Signs ...References1. Keller DA, Roe DC, Lieder PH. Fluoroacetate-mediated toxicity of fluorinated ethanes. Fundam Appl Toxicol. 1996;30:213-9. [PMID: 8812268] CrossrefMedlineGoogle Scholar2. Cates AL, Cook MD. Severe cardiomyopathy after huffing Dust-Off™. Case Rep Emerg Med. 2016;2016:9204790. [PMID: 27313914] doi:10.1155/2016/9204790 CrossrefMedlineGoogle Scholar3. Vance C, Swalwell C, McIntyre IM. Deaths involving 1,1-difluoroethane at the San Diego County medical examiner's office. J Anal Toxicol. 2012;36:626-33. [PMID: 23034927] doi:10.1093/jat/bks074 CrossrefMedlineGoogle Scholar4. Fessel JP, Oldham WM. Pyridine dinucleotides from molecules to man. Antioxid Redox Signal. 2018;28:180-212. [PMID: 28635300] doi:10.1089/ars.2017.7120 CrossrefMedlineGoogle Scholar5. Knip M, Douek IF, Moore WP, Gillmor HA, McLean AE, Bingley PJ, et al; European Nicotinamide Diabetes Intervention Trial Group. Safety of high-dose nicotinamide: a review. Diabetologia. 2000;43:1337-45. [PMID: 11126400] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Vanderbilt University Medical Center, Nashville, Tennessee (J.P.A., D.C.J., J.B.L., A.A., A.K., M.R.D., S.M., J.P.F.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0186.This article was published at Annals.org on 14 August 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAcute Refractory Hypocalcemia in a 51-Year-Old Male With a History of 1,1-Difluoroethane InhalationTwo fatalities involving 1,1-difluoroethane 4 December 2018Volume 169, Issue 11Page: 820-822KeywordsArrhythmiaBlood pressureCalciumDisclosureEjection fractionExtracorporeal membrane oxygenationFatsIntoxicationNicotinamide adenine dinucleotideSalvage antiretroviral therapy ePublished: 14 August 2018 Issue Published: 4 December 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...