title: Intensive care management following defibrillation of an adolescent girl after recreational inhalant use: a case report and review of the literature.
abstract: We report the successful out-of-hospital defibrillation and intensive care management of a 14-year-old girl who developed ventricular fibrillation following the inhalation of two 150-mL butane cigarette lighter refill canisters. Following ambulance transport to the nearest tertiary pediatric health care facility, her acute clinical course consisted of sinus tachycardia, fluctuating consciousness, and severe cerebral agitation and combativeness. Over a period of 2 weeks, her neurological function significantly improved to the point she was able to be discharged back into the community, however, not without a number of formally identified neurological deficits. Inhalant gasses, through as yet unclear mechanisms, can cause the myocardium cell membrane to become unusually sensitive to catecholamines which in turn can sometimes lead to fatal arrhythmias. This case is reported for its rarity in terms of the patient being able to be discharged back into the community and to create awareness of the sudden and potentially devastating consequences of butane inhalant use for critical care physicians and prehospital health-care personnel.
authors.affiliation: Department of Paediatric Rehabilitation, Women's & Children's Hospital, Adelaide, South Australia, Australia damith.woods@gmail.com woodsdamith@gmail.com.
authors.forename: Damith T
authors.initials: DT
authors.lastname: Woods
authors.affiliation: Department of Paediatric Intensive Care Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Perry
authors.affiliation: South Australian Ambulance Service, South Australia, Australia.
authors.forename: Stacey
authors.initials: S
authors.lastname: Solomou
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D002073:Butanes / Q000506:poisoning*; D003422:Critical Care; D004554:Electric Countershock; D005260:Female; D005740:Gases; D006801:Humans; D014693:Ventricular Fibrillation / Q000139:chemically induced* / Q000628:therapy*
chemical_list: D002073:Butanes; D005740:Gases; C046888:butane
keywords: arrhythmia; inhalant use; intensive care; ventricular fibrillation