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Battlefield Chemical Inhalation Injury
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Cyanide forms exceptionally stable complexes with the metals in a variety of metal-containing enzymes. Cyanide may combine with metalloporphyrins in concentrations as low as 33 µM. As early as 1929, cytochrome oxidase was identified as the most significantly inhibited metalloporphyrin due to its primary position in electron transfer to molecular oxygen. Because of the widespread distribution of cytochrome oxidase in the body, inhibited function as a result of cyanide binding interrupts cellular respiration in nearly all aerobic cells. Historically, therapy has been directed towards attempted binding of cyanide to other noncritical molecules such as methemoglobin. However, recent clinical studies showing that amyl nitrite reverses both the respiratory and cardiac effects of cyanide before significant methemoglobin is formed suggest that the classic theory regarding cytochrome oxidase inhibition may not be the primary lethal effect of cyanide (Vick and Froehlich, 1985). Because of the observed vasodilatory effect of amyl nitrite, further study of other vasoactive substances in cyanide poisoning has been undertaken.
Homicide
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
Burkhard Madea, Musshoff Frank, Schmidt Peter
The treatment of cyanide poisoning begins with removing the patient from exposure, administering 100 per cent oxygen, and giving aggressive cardiorespiratory support and an antidote. Inhalation of amyl nitrite has been recommended as a first-aid measure, followed by the intravenous administration of sodium nitrite and/or sodium thiosulfate. Nitrites induce methaemoglobinaemia, which detoxifies cyanide by forming cyanomethaemoglobin. Thiosulfate serves as a sulfur donor in the rhodanese-catalyzed conversion of cyanide to less toxic thiocyanate. Methaemoglobin levels should be monitored serially during treatment. Blood cyanide levels are useful in confirming the diagnosis of intoxication, but therapeutic interventions must usually be initiated before the results of analysis are available.
Novel psychoactive substances and inhalants
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Inhalant use is among the most prevalent, pernicious, and poorly understood forms of adolescent drug use (Lubman et al., 2006), and inhalants are the only class of substances abused more by younger than older teenagers (NIDA Drug facts). Nonetheless, their abuse is not limited to early adolescence and is not just a transitory behaviour among adolescents (Neumark et al., 1998). Medical anaesthetics, such as the antiquated diethyl ether and chloroform and the dental anaesthetic nitrous oxide (‘laughing gas’), can also be inhaled and abused, especially by medical and dental personnel. The latter is also available in whipped cream aerosol containers (‘whippets’) and is particularly abused by older adolescents. A particular chemical class, the alkyl nitrites that are mainly sold in small bottles or glass capsules (‘poppers’) are also inhaled for recreational purposes, especially as sexual enhancers among the adult gay population. They have been associated with HIV transmission among gay men and remain a candidate co-factor in the pathogenesis of AIDS-related Kaposi’s sarcoma (Haverkos et al., 1994; Fung and Tran, 2006). Both poppers and whippets have also been part of the club and rave cultures since the 1970s (Alcohol Concern and DrugScope, 2007).
Characteristics and circumstances of volatile solvent misuse-related death in Australia, 2000–2021
Published in Clinical Toxicology, 2023
Shane Darke, Emma Zahra, Johan Duflou, Amy Peacock, Michael Farrell, Julia Lappin
All closed cases (i.e., the coronial investigation had been completed) of volatile solvent misuse-related death aged ≥15 years at the time of death occurring between 1 July 2000 and 31 December 2021 were retrieved and inspected by the authors. Searches were conducted using the National Coronial Information System “Other non-pharmaceutical chemical substance” coding fields set contributory to death for “Fuel or solvent”, “Glue or adhesive”, “Paint, coating or stripping agents”, and “Cleaning agents”. In addition, the National Coronial Information System Drug coding fields set of “Pharmaceutical substance for human use” contributory to death were searched for “Nitrous oxide”. Text searches for amyl nitrite and alkyl nitrite were also conducted. Final searches were conducted in October 2022. Intentional self-harm was determined by the National Coronial Information System “Intentional self-harm” intent designation code. The identification of the incriminating volatile substances was determined by the coroner from toxicology and/or crime scene evidence.
Use of “Poppers” among Adults in the United States, 2015-2017
Published in Journal of Psychoactive Drugs, 2020
Austin Le, Andrew Yockey, Joseph J. Palamar
Known colloquially as “poppers”, alkyl nitrites are potent vasodilators with a long history of recreational use, surging in popularity during the 1970s within the nightlife scene (Sharp and Stillman 1980). The slang term arose from the fact that nitrites were sold in glass vials that had squeezed or “popped” between one’s fingers in order to release the vapor (French and Power 1997). Originally prescribed for the medical management of angina in the mid-nineteenth century (Lauder Brunton 1867), inhaling poppers became popular among the gay community in large part because of their relaxative effects on smooth muscles in the anal sphincter, thereby facilitating anal intercourse as well as enhancing sexual pleasure (Colfax et al. 2001; Vaccher et al. 2020; Zhao et al. 2017). Users also commonly reported short-lasting sensations of warmth and euphoria (Mathew, Wilson, and Tant 1989; Pepper, Zuniga, and Reed 2019). Among the most common types of inhaled poppers are amyl nitrites and butyl nitrites, which are currently legal in the United States (US) and widely available – often sold under the guise of air deodorizers and cleaners – at adult stores, bars, clubs, and online (Romanelli et al. 2004; Swartz and McCarty-Caplan 2018).
Methaemoglobinaemia and oesophageal burns after accidental ingestion of an alkyl nitrite
Published in Clinical Toxicology, 2022
Jiri Hlusicka, Stanislav Sevela, Vaclav Smid, Vit Sestak, Darren M. Roberts
Alkyl nitrites are volatile liquids with multiple uses. They are sometimes used prior to sex and referred to as poppers. Alkyl nitrites are vasodilators, causing decreased blood pressure, tachycardia, headache, and relaxation of involuntary muscles. Alkyl nitrites also oxidize ferrous iron in haemoglobin to ferric iron, forming methaemoglobin which reduces the oxygen carrying capacity of blood, causing cyanosis. It is reversed by the antidote methylthioninium chloride (methylene blue). These signs and symptoms of nitrite toxicity are well described, and may be life threatening due to severe cellular hypoxia, metabolic acidaemia and shock [1].