A Fatal Case of Acute Butane-Propane Poisoning in a Prisoner Under Psychiatric Treatment

Abstract

Sudden death due to inhalation of aliphatic hydrocarbons such as butane and propane is well described in the literature. The main mechanism involved is the induction of a fatal cardiac arrhythmia. This phenomenon is frequently associated with prisoners who accidentally die while sniffing these volatile substances with an abuse purpose. Furthermore, such prisoners are often under psychiatric treatment; specific drugs belonging to this pharmacological class lead to a drug-related QT interval prolongation, setting the stage for torsade de pointes. In this article, we present the case of a prisoner died after sniffing a butane-propane gas mixture from a prefilled camping stove gas canister. The man was under psychiatric drugs due to mental disorders. He was constantly subjected to electrocardiogram to monitor the QTc (corrected QT interval), which was 460 milliseconds long. Toxicological analysis on cadaveric samples was performed by means of gas chromatography (head space) and revealed the presence of butane and propane at low levels. The aim of this article was to discuss a possible arrhythmogenic interaction of QT interval prolongation induced by psychiatric drugs and butane-propane inhalations, increasing the cardiovascular risk profile. In other words, evidence may suggest that prisoners, under these circumstances, are more likely to experience cardiovascular adverse effects. We believe that this study underlines the need to take this hypothesis into account to reduce death risk in prison and any medical-related responsibilities. Further studies are needed to validate the hypothesis.

Volatile lipophilic substances management in case of fatal sniffing

“…In Italy, the voluntary inhalation of gas cylinders is a widespread phenomenon in the prison population, where the use of gas stove in the cell is allowed and regulated by law [12][13]. In these cases, the specialists involved in the determination of the cause of death need to properly handle the samples of biologic material to allow the analysis of volatile substances, by using gas-tight containers [14].…”

The role of ethanethiol in deaths from acute poisoning by gas mixtures: A suicide case involving a decomposed corpse and a review of the literature

“…The main causes of death due to acute LPG inhalation are cardiac arrest (sudden sniffing death syndrome), asphyxia and respiratory depression, while the main causes of death due to chronic LPG inhalation are cardiomyopathy, myocardial infarction, central nervous system toxicity and haematological abnormalities. 1,3,[5][6][7][8][9][10][11] The post-mortem analysis of the effect of these gases on biological fluids and tissues is performed by gas chromatography (GC-MS, (HS)-GC-MS). 6,9,12 Case report Here, we report the case of a 30-year-old man of Belarusian origin found dead in his house (room temperature: 26 C).…”