Difluoroethane toxicity: Difference between revisions

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*Though considered non-toxic for industrial use, DFE is increasingly recognized as a substance of abuse, especially among adolescents and young adults, due to its rapid-onset euphoric effects when inhaled—a practice known as "huffing."
*Though considered non-toxic for industrial use, DFE is increasingly recognized as a substance of abuse, especially among adolescents and young adults, due to its rapid-onset euphoric effects when inhaled—a practice known as "huffing."


== Key Pearls ==
===Key Pearls===
* Sudden cardiac death from DFE abuse can occur in previously healthy individuals.
* Sudden cardiac death from DFE abuse can occur in previously healthy individuals.
* Always obtain an EKG and initiate cardiac monitoring.
* Always obtain an EKG and initiate cardiac monitoring.
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=== Pathophysiology ===
=== Pathophysiology ===
DFE is rapidly absorbed through the lungs and acts primarily as a CNS depressant. Its volatile properties and lipid solubility allow it to penetrate the brain quickly, producing an intoxicating effect within seconds of inhalation.
*Rapidly absorbed through the lungs  
*Acts primarily as a CNS depressant
**Volatile properties and lipid solubility allow it to penetrate the brain quickly, producing an intoxicating effect within seconds of inhalation.
 


Key pathophysiologic effects:
Key pathophysiologic effects:
* Sensitization of myocardium to catecholamines → increased risk of fatal arrhythmias ("sudden sniffing death")
* Sensitization of myocardium to catecholamines → increased risk of fatal arrhythmias ("sudden sniffing death")
* Hypoxia and asphyxia due to displacement of alveolar oxygen
* Hypoxia and asphyxia due to displacement of alveolar oxygen
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== Clinical Features ==
== Clinical Features ==
=== Acute Presentation: ===
=== Acute Presentation ===
* Euphoria, dizziness, slurred speech
* Euphoria, [[dizziness]], slurred speech
* Confusion, ataxia, lethargy
* Confusion, ataxia, lethargy
* Nausea, vomiting
* [[Nausea]], [[vomiting]]
* Seizures, particularly in high-dose exposure
* [[Seizures]], particularly in high-dose exposure
* Syncope or cardiac arrest (especially with exertion or catecholamine surge)
* [[Syncope]] or [[cardiac arrest]] (especially with exertion or catecholamine surge)


=== Cardiac Effects ===
=== Cardiac Effects ===
* Palpitations
* [[Palpitations]]
* Premature ventricular contractions (PVCs)
* [[Premature ventricular contractions]] (PVCs)
* Ventricular tachycardia/fibrillation
* [[Ventricular tachycardia]]/fibrillation
* QT prolongation, possibly torsades de pointes
* [[QT prolongation]], possibly [[torsades de pointes]]


=== Pulmonary Effects ===
=== Pulmonary Effects ===
* Cough, dyspnea
* [[Cough]], [[dyspnea]]
* Chemical pneumonitis
* Chemical pneumonitis
* Pulmonary hemorrhage (in rare cases)
* [[Pulmonary hemorrhage]] (in rare cases)


=== Chronic Use ===
=== Chronic Use ===
* Cognitive decline
* Cognitive decline
* Peripheral neuropathy
* [[Peripheral neuropathy]]
* Hepatotoxicity or nephrotoxicity
* Hepatotoxicity or nephrotoxicity
* Dermal frostbite or oronasal irritation from direct contact with aerosol can
* Dermal [[frostbite]] or oronasal irritation from direct contact with aerosol can


==Differential Diagnosis==
==Differential Diagnosis==
{{Drugs of abuse types}}
{{Toxic gas exposure DDX}}


==Evaluation==
==Evaluation==
===Workup===
===Workup===
* EKG: assess for QT prolongation, PVCs, ventricular arrhythmias
* [[ECG]]: assess for [[QT prolongation]], [[PVCs]], ventricular arrhythmias
* Cardiac monitoring
* Cardiac monitoring
* Chest X-ray if respiratory symptoms are present
* [[Chest X-ray]] if respiratory symptoms are present
* Basic labs:
* Basic labs:
** CBC, BMP, troponin
** CBC, BMP, troponin
** Creatinine kinase (CK)
** Creatinine kinase (CK)
** ABG if hypoxia suspected
** [[ABG]] if hypoxia suspected
** Urine toxicology screen: may not detect difluoroethane but can help rule out co-ingestions
** [[Urine toxicology screen]]: may not detect difluoroethane but can help rule out co-ingestions


===Diagnosis===
===Diagnosis===
* Consider DFE toxicity in any young patient with sudden unexplained arrhythmia, altered mental status, or seizure
* Consider DFE toxicity in any young patient with sudden unexplained arrhythmia, [[altered mental status]], or [[seizure]]
* Ask about recent use of aerosol sprays, cleaning products, or refrigerants
* Ask about recent use of aerosol sprays, cleaning products, or refrigerants
* Look for signs of inhalant abuse:
* Look for signs of [[inhalant abuse]]:
** Chemical odor on breath
** Chemical odor on breath
** Perioral or hand burns
** Perioral or hand burns
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==Management==
==Management==
Supportive Care is the Mainstay:
===Supportive Care===
* Airway, breathing, circulation (ABCs)
* Airway, breathing, circulation (ABCs)
* Supplemental oxygen as needed
* Supplemental [[oxygen]] as needed
* Continuous cardiac monitoring due to risk of arrhythmia
* Continuous cardiac monitoring due to risk of [[arrhythmia]]
* Avoid catecholamines (e.g., epinephrine, norepinephrine) unless absolutely necessary—may precipitate fatal arrhythmias
* Avoid catecholamines (e.g., [[epinephrine]], [[norepinephrine]]) unless absolutely necessary—may precipitate fatal arrhythmias


Treat Complications as They Arise:
===Treat Complications if Applicable===
* Ventricular arrhythmias → defibrillation, amiodarone (avoid lidocaine in some cases)
* Ventricular arrhythmias → [[defibrillation]], [[amiodarone]] (avoid [[lidocaine]] in some cases)
* Seizures → benzodiazepines
* [[Seizures]] → [[benzodiazepines]]
* Respiratory failure or chemical pneumonitis → consider intubation and supportive ventilation
* [[Respiratory failure]] or chemical pneumonitis → consider [[intubation]] and supportive ventilation
* Skin or mucosal injury → treat as chemical burns or frostbite
* Skin or mucosal injury → treat as [[chemical burns]] or [[frostbite]]


==Disposition==
==Disposition==
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* No signs of pulmonary or neurologic complications
* No signs of pulmonary or neurologic complications


==Referral Considerations===
====Referral Considerations====
* Substance abuse counseling or addiction medicine
* Substance abuse counseling or addiction medicine
* Consider social work consult for adolescents or vulnerable individuals
* Consider social work consult for adolescents or vulnerable individuals

Latest revision as of 23:04, 10 December 2025

Background

A common source of Difluoroethane
  • Difluoroethane (DFE) is a hydrofluorocarbon (HFC) commonly used as a propellant in aerosol products, including computer keyboard cleaners and refrigerants.
  • Though considered non-toxic for industrial use, DFE is increasingly recognized as a substance of abuse, especially among adolescents and young adults, due to its rapid-onset euphoric effects when inhaled—a practice known as "huffing."

Key Pearls

  • Sudden cardiac death from DFE abuse can occur in previously healthy individuals.
  • Always obtain an EKG and initiate cardiac monitoring.
  • Do not rely on routine tox screens—DFE often won’t show up.
  • Avoid exogenous catecholamines if arrhythmia risk is present.
  • Suspect DFE in cases of unexplained syncope, seizures, or cardiac arrest—especially in youth or with aerosol products nearby

Pathophysiology

  • Rapidly absorbed through the lungs
  • Acts primarily as a CNS depressant
    • Volatile properties and lipid solubility allow it to penetrate the brain quickly, producing an intoxicating effect within seconds of inhalation.


Key pathophysiologic effects:

  • Sensitization of myocardium to catecholamines → increased risk of fatal arrhythmias ("sudden sniffing death")
  • Hypoxia and asphyxia due to displacement of alveolar oxygen
  • Central nervous system depression, including coma and seizures
  • Pulmonary injury: inflammation, hemorrhage, and edema
  • Hepatic and renal injury with chronic or massive exposure

Clinical Features

Acute Presentation

Cardiac Effects

Pulmonary Effects

Chronic Use

Differential Diagnosis

Drugs of abuse

Toxic gas exposure

Evaluation

Workup

  • ECG: assess for QT prolongation, PVCs, ventricular arrhythmias
  • Cardiac monitoring
  • Chest X-ray if respiratory symptoms are present
  • Basic labs:
    • CBC, BMP, troponin
    • Creatinine kinase (CK)
    • ABG if hypoxia suspected
    • Urine toxicology screen: may not detect difluoroethane but can help rule out co-ingestions

Diagnosis

  • Consider DFE toxicity in any young patient with sudden unexplained arrhythmia, altered mental status, or seizure
  • Ask about recent use of aerosol sprays, cleaning products, or refrigerants
  • Look for signs of inhalant abuse:
    • Chemical odor on breath
    • Perioral or hand burns
    • Empty aerosol cans
    • Skin frostbite

Management

Supportive Care

  • Airway, breathing, circulation (ABCs)
  • Supplemental oxygen as needed
  • Continuous cardiac monitoring due to risk of arrhythmia
  • Avoid catecholamines (e.g., epinephrine, norepinephrine) unless absolutely necessary—may precipitate fatal arrhythmias

Treat Complications if Applicable

Disposition

Admission

  • Persistent arrhythmias or EKG abnormalities
  • Seizure activity
  • Altered mental status or respiratory compromise
  • Suspicion of recurrent or chronic use (requires observation)

Discharge

  • Normal mental status
  • Normal EKG and cardiac monitoring for at least 4–6 hours post-exposure
  • No signs of pulmonary or neurologic complications

Referral Considerations

  • Substance abuse counseling or addiction medicine
  • Consider social work consult for adolescents or vulnerable individuals
  • Outpatient follow-up with primary care or mental health services

See Also

External Links

References

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