Acute inhalational abuse

A 23 year old male was found in bed unresponsive and gasping for air six hours after having been drinking with friends. Mouth-to-mouth resuscitation was given and a strong odour of chloroform was detected on the breath. Next to the bed was a bottle of laboratory grade chloroform and a chloroform soaked towel. A short run of ventricular tachycardia was observed which reverted to sinus rhythm without treatment. He was intubated and ventilated. On admission he was responsive only to painful stimuli, with constricted pupils and absent deep tendon reflexes. Diffuse rhonchi and wheezes were heard over both lung fields. Metabolic acidosis improved with sodium bicarbonate. He had an episode of bradycardia and arterial hypotension which resolved with sodium chloride infusion. He remained unconscious with arterial hypoxaemia and required positive expiratory end pressure (PEEP) ventilation. He became increasingly alert and his condition improved. He was weaned off the ventilator on the 2nd hospital day. He admitted intentionally inhaling an unknown amount of chloroform 'to see what would happen'. During the next few days he complained of nausea and poor appetite. By the 6th day he had jaundice of the skin and sclerae without liver or spleen enlargement. This resolved rapidly and he was discharged on the 12th day. The hypoxaemia and lung changes were thought to be due to aspiration of gastric contents before or during oro-tracheal intubation. A liver biopsy on day 11 revealed resolving centrilobular necrosis with fatty droplets within the mid-zonal surviving cells, dropout of hepatocytes and dilated sinusoids lined by Kupffer cells (Hutchens and Kung, 1985).

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