title: Is it worth carrying out determination of N-butane in postmortem samples? A case report and a comprehensive review of the literature.
abstract: The aim of this article is to illustrate the importance of N-butane determination in postmortem samples through a case report and to propose actions and precautions to be taken into consideration when butane is suspected to be involved in cases of death. The case concerns a 15-year-old boy found dead after sniffing a cigarette lighter refill. Toxicological investigation revealed the presence of butane in the heart and femoral blood (1280 and 1170 μg/L, respectively), in the gastric contents (326 μg/L), and in the liver (1010 μg/kg) and lung tissues (210 μg/kg). Propane was present only in the blood samples at concentrations tenfolds lower.Butane can be involved in three kinds of fatalities: deliberate inhalations including volatile substance abuse (VSA), involuntary exposure, and homicides. A fatal outcome of butane inhalation can be caused by asphyxia and/or cardiac arrhythmia. In the context where butane exposure is evidenced by non-toxicological investigations, the usefulness of the determination of butane in postmortem samples is often questionable. However, it is admitted that butane-related deaths are generally underreported. Several difficulties including sample handling and storage, substantial variation in tissue concentrations, and lack of a lethal threshold make the interpretation of butane results challenging. In our opinion, systematic toxicological methods should be developed in order to analyze butane, at least when it concerns a typical VSA victim, even when butane is not actually suspected to be the cause of death.
authors.affiliation: Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire de Limoges, 87042, Limoges Cedex, France. souleiman.elbalkhi@chu-limoges.fr.
authors.forename: Souleiman
authors.initials: S
authors.lastname: El Balkhi
authors.affiliation: Department of Forensic medicine, Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Coutaz-Fluck
authors.affiliation: Department of Forensic medicine, Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Moreau
authors.affiliation: Department of Forensic medicine, Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: François
authors.initials: F
authors.lastname: Paraf
authors.affiliation: Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire de Limoges, 87042, Limoges Cedex, France.|Unit of Toxicology, University Hospital of Lille, Lille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaulier
mesh_terms: D000293:Adolescent; D002073:Butanes / Q000032:analysis* / Q000506:poisoning*; D002853:Chromatography, Liquid; D003645:Death, Sudden / Q000209:etiology; D053593:Forensic Toxicology; D006801:Humans; D058545:Inhalant Abuse; D008297:Male; D013058:Mass Spectrometry; D011407:Propane / Q000097:blood
chemical_list: D002073:Butanes; C046888:butane; D011407:Propane
keywords: Butane; Sudden death syndrome; Volatile substance abuse