Case Presentation:
A 26-year-old man with a past medical history of depression and chronic pain presented to the hospital with severe shortness of breath, chest pain, diffuse numbness, nausea, and vomiting. Questioning revealed the symptoms began after inhaling Dust Off for a cumulative 3 hour period. His vital signs showed BP 98/85 mmHg, HR 160 beats per minute, RR 32 breaths per minute, and SpO2 95% on 15L oxygen via non-rebreather mask. He was alert and oriented, although he was in moderate distress with agitation, labored breathing, diffuse expiratory wheezing, diaphoresis, and decreased sensation in all extremities. Abnormal labs included lactate 9.7 mmol/L, arterial pH 7.259, PaCO2 24.3 mmHg, bicarbonate 18 mmol/L, anion gap 32, creatinine 1.7 mg/dL, troponin 0.04 ng/mL, ionized calcium 2.8 mg/dL (4.7-5.4), and magnesium 0.7 mg/dL (1.8-2.5). EKG showed sinus tachycardia with right bundle branch block. He was resuscitated with 5L of intravenous NS, administered sodium bicarbonate, and started on an esmolol via continuous infusion. Electrolytes were repleted and dexmedetomidine was administered via continuous infusion. He continued to deteriorate, requiring BiPAP and emergent central line placement. After the central line was placed, the patient went into ventricular fibrillation. ACLS was immediately initiated and despite aggressive attempts at resuscitation for 45 minutes, he expired.
Discussion:
Dust Off is a common household item frequently called “canned air,” which is a misnomer as there is an active ingredient, 1,1-Difluoroethane. Excessive inhalation “huffing” of this compound is reported to cause confusion, tremors, pulmonary irritation, coma, and death. Hypoxia occurs secondary to displacement of oxygen molecules. Myocardial sensitization and electrolyte abnormalities occur which alter the cardiac conduction system. Treatment includes removal of the offending agent, supportive care, oxygen administration, aggressive airway management, a quiet environment, electrolyte replacement, and esmolol for tachydysrhythmias.
Conclusions:
Huffing is a mechanism by which one can experience a transient sense of euphoria. Lack of education about potential health hazards in combination with easy access to items that provide this sensation create a perfect storm for abuse. As long as “canned air” is available, it is important for physicians to recognize its potential devastating effects and know the proper management.