Journal of Toxicology: Clinical Toxicology
ISSN: 0731-3810 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/ictx19
Recreational Propane Inhalation in an Adolescent Male Margot G. Wheeler, Alan A. Rozycki & Roger P. Smith To cite this article: Margot G. Wheeler, Alan A. Rozycki & Roger P. Smith (1992) Recreational Propane Inhalation in an Adolescent Male, Journal of Toxicology: Clinical Toxicology, 30:1, 135-139, DOI: 10.3109/15563659208994454 To link to this article: http://dx.doi.org/10.3109/15563659208994454
Published online: 25 Sep 2008.
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Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ictx19 Download by: [McMaster University]
Date: 16 March 2016, At: 20:01
CLINICAL TOXICOLOGY, 30(1) 135-139 (1992)
BRIEF REPORT
Downloaded by [McMaster University] at 20:01 16 March 2016
RECREATIONAL PROPANE INHALATION IN AN ADOLESCENT MALE
Margot G. Wheeler, M.D.*; Alan A. Rozycki, M.D.*; Roger P. Smith, Ph.D.** Department of Maternal and Child Health*; Department of Pharmacology and Toxicology**, Dartmouth Medical School, Hanover, New Hampshire
ABSTRACT Propane inhalation may be widespread, yet only a few cases have been reported. The victims were usually found dead, and only one other report describes firsthand the sought-after effects. We report on a 17 year-old male with a six month history of repeated inhalation. The patient manifested no pathophysiologic signs, but the ready availability of propane may result in an increase in its abuse. This activity carries considerable risk for trauma and/or sudden death. Our patient was able to recruit others to the practice by finding ways to avoid some of the unique, inherent deterrents. (Key Words: propane abuse; recreational inhalation of propane; inhalant abuse, propane.)
Address reprint requests to: Dr. Roger P. Smith, Department of Pharmacology and Toxicology, Dartmouth Medical School, Hanover, NH
03756. 135 Copyright
1992 by Marcel Dekker, Inc.
136
WHEELER, ROZYCKI, AND SMITH
Downloaded by [McMaster University] at 20:01 16 March 2016
INTRODUCTION Liquified propane gas is available in pressurized tanks for use in cooking and propane torches. Accidental inhalation by an infant resulted in seizures and ventricular tachycardia; recovery was without sequelae (1). It was used in at least one successful suicide (2). There are reports of apparent recreational use in which victims were found dead (3,4). In only one of these episodes were companions able to relate what had happened. The group was engaged in "torch breathing" by igniting the exhaled gas (4). It is not clear if this incident represented abuse for alleged psychedelic effects or for the thrilling pyrotechnics. We believe our case represents true propane abuse because it was long-standing, because others were recruited to it, and because measures were taken to avoid certain unpleasant aspects of the practice. Case ReDort A 17 year-old male was referred to our clinic by a social worker pending his admission to a drug rehabilitation facility for a voluntary 30-day treatment. He was also interviewed after treatment and there were no significant discrepancies in his accounts. He was highly motivated and quite frank in reporting six months of daily, voluntary inhalation of propane from barbecue grill tanks and propane torches. With three to five peers, the patient would use his parent's grill or steal a bottle from a grill in his neighborhood. As a means of "getting high," he and his friends inhaled the propane by inserting the line from the gas bottle into their mouths and opening the valve for periods of 10 to 15 seconds during inspiration. When using a propane torch, the gas was delivered either by pressure, or as the container emptied, by gravity. After inhalation the patient would hold his breath for up to one minute before expiration. During these episodes, he experienced feelings of euphoria, ataxia, and lightheadedness without loss of consciousness. These sensations typically lasted one to two minutes, after which the inhalation would be repeated; this pattern would be continued for periods of up to three hours.
Downloaded by [McMaster University] at 20:01 16 March 2016
TEENAGE PROPANE ABUSE
137
The patient described some adverse effects from inhalation. When the gas flowed through the line from the tank,the metal valve in the patient’s mouth became cold and froze to his lips and tongue causing them to bleed. He solved this problem by designing a plastic cuff to surround the metal fitting. Because of the foul taste and smell of the gas, the patient cleared his mouth with soft drinks and frequent expectoration. He also described severe headaches on mornings after, and he had concerns about memory loss. His substance abuse history included at least two years of daily marijuana use, and the inhalation of lighter and typewriter correction fluids. Physical examination revealed a lean, muscular boy without distress; the exam was within normal limits including a neurological assessment. Mental status and affect were normal and appropriate for age. Laboratory tests revealed no abnormalities in CBC with differential, blood urea nitrogen, serum creatinine, electrolytes, routine urinalysis, or liver function studies. Psychometric studies were not performed.
DISCUSSION Propane is a low molecular weight alkane that exists as a colorless gas at sea level pressures with a vapor density of 1.6 (air = 1). Bottled gas typically consists of propane (95%), ethane (4%), and trace amounts of isobutane and butane (< 1%). The noxious taste and aroma are due to the addition of ethyl mercaptan to serve as a warning of gas leakage (5). Despite the taste and odor, the patient was not deterred from using propane. The current OSHA standard for propane in the workplace is 10oO ppm, the odor threshold is 20 OOO ppm, and the irritant threshold is 100 OOO ppm. Our patient was exposed to propane levels far in excess of these. He began using propane at the suggestion of a friend, and soon recruited others to the practice, The popularity of propane is understandable by its availability at low or no cost and a low index of suspicion about its purchase. In this case, side effects were not a deterrent. The gas line injury to the lips and tongue was due to the latent heat of vaporization as the pressure was released on the liquified gas. Heat absorbed from tissues generated temperatures low enough to damage the
Downloaded by [McMaster University] at 20:01 16 March 2016
138
WHEELER, ROZYCKI, AND SMITH
mucous membranes even in the short time in which they were in direct contact with the metal. Our patient had no permanent sequelae from these burns, but accidental occupational exposure to liquid propane caused injuries warranting surgical intervention (6). Since the mechanism of inhalation described precludes mixing with air, and the inhaled gas was completely devoid of oxygen, propane could be acting as a simple asphyxiant. Death possibly due to hypoxemia secondary to propane inhalation has been reported among abusers (3,4). This potential for asphyxiation could be magnified due to the anesthetic properties of propane. It reaches the anesthetic range in cats at 93 vol 96 (5,7), a concentration perhaps achievable by our patient for short periods of time. The lightheadedness experienced by the patient may actually be presyncopal episodes. Propane intensified epinephrine-induced cardiac arrhythmias in dogs and mice (8,9), but not in monkeys (10). Others have reported bronchoconstriction and respiratory depression in animals (10). Any or all of these may have played a role in the reported human deaths (2-4). Propane’s explosive potential is significant at two to ten percent concentrations in air (11). Inhalation of propane in the presence of an open flame is obviously hazardous. The risk of explosion in this patient was greatly increased by his cross-addiction to marijuana and tobacco.
CONCLUSION Propane has not been described as a substance with recognized potential for long-standing abuse. Our assessment of the effects of propane in this patient was complicated by a lack of data on the effects of chronic propane inhalation. Despite normal findings on physical examination, we are concerned about the potential explosive, asphyxiant and arrhythmogenic hazards associated with propane abuse. Its availability to minors could make propane inhalation attractive to adolescents with a history of substance abuse.
TEENAGE PROPANE ABUSE
139
ACKNOWLEDGEMENT Dr. Wheeler’s present address is Department of Medicine, National Naval Medical Center, Bethesda, MD 20814. This report was in part supported by Grant HL 14127 from the National Institute of Health.
Downloaded by [McMaster University] at 20:01 16 March 2016
REFERENCES
1. 2.
3. 4.
5. 6. 7.
8.
Wason S , Gibler WB, Hassan M. Ventricular tachycardia associated with non-freon aerosol propellants. JAMA 1986;256:78-80. Imami RH, Kemal M. Propane asphyxiation. Am J Forensic Med Pathol 1986;7:76-77. Haq MZ, Hameli AZ. A death involving asphyxiation from propane inhalation. J Forensic Sci 1980;25:25-28. Siege1 E,Wason S. Sudden death caused by inhalation of butane and propane. N Engl J Med 1990;323:1638. Gosselin RE, Smith RP, Hodge HC. Clinical Toxicology of Commercial Producfs, 5th ed. Baltimore: Williams & Wilkins, 1984:11-150. Hicks LM, Hunt JL, Baxter CR. Liquid propane cold injury: a clinicopathologic and experimental study. J T r a m 1979; 19:701-703. Moore AF. Final report of the safety assessment of isobutane, isopentane, n-butane and propane. J Am Coll Toxicol1982;l:127-142. Krantz JC Jr, Carr CJ, Vitcha JF. A study of cyclic and noncyclic hydrocarbons on cardiac automaticity. J Pharmacol Exp Ther 1948;
941315-318.
9. 10. 11.
Aviado DM, Belej MA. Toxicity of aerosol propellants on the respiratory and circulatory systems. 1. Cardiac arrhythmia in the mouse. Toxicology 1974;2:31-42. Belej MA, Smith DG, Aviado DM. Toxicity of aerosol propellants on the respiratory and circulatory systems. IV. Cardiotoxicity in the monkey. Toxicology 1974;2:381-395. Aviado DM, Smith DG. Toxicity of aerosol propellants on the respiratory and circulatory systems. VIII. Respiration and circulation in primates. Toxicology 1975;3:241-252.
ISSN: 0731-3810 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/ictx19
Recreational Propane Inhalation in an Adolescent Male Margot G. Wheeler, Alan A. Rozycki & Roger P. Smith To cite this article: Margot G. Wheeler, Alan A. Rozycki & Roger P. Smith (1992) Recreational Propane Inhalation in an Adolescent Male, Journal of Toxicology: Clinical Toxicology, 30:1, 135-139, DOI: 10.3109/15563659208994454 To link to this article: http://dx.doi.org/10.3109/15563659208994454
Published online: 25 Sep 2008.
Submit your article to this journal
Article views: 10
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ictx19 Download by: [McMaster University]
Date: 16 March 2016, At: 20:01
CLINICAL TOXICOLOGY, 30(1) 135-139 (1992)
BRIEF REPORT
Downloaded by [McMaster University] at 20:01 16 March 2016
RECREATIONAL PROPANE INHALATION IN AN ADOLESCENT MALE
Margot G. Wheeler, M.D.*; Alan A. Rozycki, M.D.*; Roger P. Smith, Ph.D.** Department of Maternal and Child Health*; Department of Pharmacology and Toxicology**, Dartmouth Medical School, Hanover, New Hampshire
ABSTRACT Propane inhalation may be widespread, yet only a few cases have been reported. The victims were usually found dead, and only one other report describes firsthand the sought-after effects. We report on a 17 year-old male with a six month history of repeated inhalation. The patient manifested no pathophysiologic signs, but the ready availability of propane may result in an increase in its abuse. This activity carries considerable risk for trauma and/or sudden death. Our patient was able to recruit others to the practice by finding ways to avoid some of the unique, inherent deterrents. (Key Words: propane abuse; recreational inhalation of propane; inhalant abuse, propane.)
Address reprint requests to: Dr. Roger P. Smith, Department of Pharmacology and Toxicology, Dartmouth Medical School, Hanover, NH
03756. 135 Copyright
1992 by Marcel Dekker, Inc.
136
WHEELER, ROZYCKI, AND SMITH
Downloaded by [McMaster University] at 20:01 16 March 2016
INTRODUCTION Liquified propane gas is available in pressurized tanks for use in cooking and propane torches. Accidental inhalation by an infant resulted in seizures and ventricular tachycardia; recovery was without sequelae (1). It was used in at least one successful suicide (2). There are reports of apparent recreational use in which victims were found dead (3,4). In only one of these episodes were companions able to relate what had happened. The group was engaged in "torch breathing" by igniting the exhaled gas (4). It is not clear if this incident represented abuse for alleged psychedelic effects or for the thrilling pyrotechnics. We believe our case represents true propane abuse because it was long-standing, because others were recruited to it, and because measures were taken to avoid certain unpleasant aspects of the practice. Case ReDort A 17 year-old male was referred to our clinic by a social worker pending his admission to a drug rehabilitation facility for a voluntary 30-day treatment. He was also interviewed after treatment and there were no significant discrepancies in his accounts. He was highly motivated and quite frank in reporting six months of daily, voluntary inhalation of propane from barbecue grill tanks and propane torches. With three to five peers, the patient would use his parent's grill or steal a bottle from a grill in his neighborhood. As a means of "getting high," he and his friends inhaled the propane by inserting the line from the gas bottle into their mouths and opening the valve for periods of 10 to 15 seconds during inspiration. When using a propane torch, the gas was delivered either by pressure, or as the container emptied, by gravity. After inhalation the patient would hold his breath for up to one minute before expiration. During these episodes, he experienced feelings of euphoria, ataxia, and lightheadedness without loss of consciousness. These sensations typically lasted one to two minutes, after which the inhalation would be repeated; this pattern would be continued for periods of up to three hours.
Downloaded by [McMaster University] at 20:01 16 March 2016
TEENAGE PROPANE ABUSE
137
The patient described some adverse effects from inhalation. When the gas flowed through the line from the tank,the metal valve in the patient’s mouth became cold and froze to his lips and tongue causing them to bleed. He solved this problem by designing a plastic cuff to surround the metal fitting. Because of the foul taste and smell of the gas, the patient cleared his mouth with soft drinks and frequent expectoration. He also described severe headaches on mornings after, and he had concerns about memory loss. His substance abuse history included at least two years of daily marijuana use, and the inhalation of lighter and typewriter correction fluids. Physical examination revealed a lean, muscular boy without distress; the exam was within normal limits including a neurological assessment. Mental status and affect were normal and appropriate for age. Laboratory tests revealed no abnormalities in CBC with differential, blood urea nitrogen, serum creatinine, electrolytes, routine urinalysis, or liver function studies. Psychometric studies were not performed.
DISCUSSION Propane is a low molecular weight alkane that exists as a colorless gas at sea level pressures with a vapor density of 1.6 (air = 1). Bottled gas typically consists of propane (95%), ethane (4%), and trace amounts of isobutane and butane (< 1%). The noxious taste and aroma are due to the addition of ethyl mercaptan to serve as a warning of gas leakage (5). Despite the taste and odor, the patient was not deterred from using propane. The current OSHA standard for propane in the workplace is 10oO ppm, the odor threshold is 20 OOO ppm, and the irritant threshold is 100 OOO ppm. Our patient was exposed to propane levels far in excess of these. He began using propane at the suggestion of a friend, and soon recruited others to the practice, The popularity of propane is understandable by its availability at low or no cost and a low index of suspicion about its purchase. In this case, side effects were not a deterrent. The gas line injury to the lips and tongue was due to the latent heat of vaporization as the pressure was released on the liquified gas. Heat absorbed from tissues generated temperatures low enough to damage the
Downloaded by [McMaster University] at 20:01 16 March 2016
138
WHEELER, ROZYCKI, AND SMITH
mucous membranes even in the short time in which they were in direct contact with the metal. Our patient had no permanent sequelae from these burns, but accidental occupational exposure to liquid propane caused injuries warranting surgical intervention (6). Since the mechanism of inhalation described precludes mixing with air, and the inhaled gas was completely devoid of oxygen, propane could be acting as a simple asphyxiant. Death possibly due to hypoxemia secondary to propane inhalation has been reported among abusers (3,4). This potential for asphyxiation could be magnified due to the anesthetic properties of propane. It reaches the anesthetic range in cats at 93 vol 96 (5,7), a concentration perhaps achievable by our patient for short periods of time. The lightheadedness experienced by the patient may actually be presyncopal episodes. Propane intensified epinephrine-induced cardiac arrhythmias in dogs and mice (8,9), but not in monkeys (10). Others have reported bronchoconstriction and respiratory depression in animals (10). Any or all of these may have played a role in the reported human deaths (2-4). Propane’s explosive potential is significant at two to ten percent concentrations in air (11). Inhalation of propane in the presence of an open flame is obviously hazardous. The risk of explosion in this patient was greatly increased by his cross-addiction to marijuana and tobacco.
CONCLUSION Propane has not been described as a substance with recognized potential for long-standing abuse. Our assessment of the effects of propane in this patient was complicated by a lack of data on the effects of chronic propane inhalation. Despite normal findings on physical examination, we are concerned about the potential explosive, asphyxiant and arrhythmogenic hazards associated with propane abuse. Its availability to minors could make propane inhalation attractive to adolescents with a history of substance abuse.
TEENAGE PROPANE ABUSE
139
ACKNOWLEDGEMENT Dr. Wheeler’s present address is Department of Medicine, National Naval Medical Center, Bethesda, MD 20814. This report was in part supported by Grant HL 14127 from the National Institute of Health.
Downloaded by [McMaster University] at 20:01 16 March 2016
REFERENCES
1. 2.
3. 4.
5. 6. 7.
8.
Wason S , Gibler WB, Hassan M. Ventricular tachycardia associated with non-freon aerosol propellants. JAMA 1986;256:78-80. Imami RH, Kemal M. Propane asphyxiation. Am J Forensic Med Pathol 1986;7:76-77. Haq MZ, Hameli AZ. A death involving asphyxiation from propane inhalation. J Forensic Sci 1980;25:25-28. Siege1 E,Wason S. Sudden death caused by inhalation of butane and propane. N Engl J Med 1990;323:1638. Gosselin RE, Smith RP, Hodge HC. Clinical Toxicology of Commercial Producfs, 5th ed. Baltimore: Williams & Wilkins, 1984:11-150. Hicks LM, Hunt JL, Baxter CR. Liquid propane cold injury: a clinicopathologic and experimental study. J T r a m 1979; 19:701-703. Moore AF. Final report of the safety assessment of isobutane, isopentane, n-butane and propane. J Am Coll Toxicol1982;l:127-142. Krantz JC Jr, Carr CJ, Vitcha JF. A study of cyclic and noncyclic hydrocarbons on cardiac automaticity. J Pharmacol Exp Ther 1948;
941315-318.
9. 10. 11.
Aviado DM, Belej MA. Toxicity of aerosol propellants on the respiratory and circulatory systems. 1. Cardiac arrhythmia in the mouse. Toxicology 1974;2:31-42. Belej MA, Smith DG, Aviado DM. Toxicity of aerosol propellants on the respiratory and circulatory systems. IV. Cardiotoxicity in the monkey. Toxicology 1974;2:381-395. Aviado DM, Smith DG. Toxicity of aerosol propellants on the respiratory and circulatory systems. VIII. Respiration and circulation in primates. Toxicology 1975;3:241-252.
