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Adolescents, typically individuals aged 13-25, are often characterized by their propensity for engaging in risky behaviors, which can be alarming to more mature adults. This report explores the consequences of such behavior, specifically focusing on the inhalation of butane gas and its potential to lead to cardiac arrest.
Adolescence is a developmental period marked by suboptimal decision-making and actions associated with a higher incidence of unintentional injuries, violence, substance abuse, unintended pregnancy, and sexually transmitted diseases (Casey, Jones, & Hare, 2008).
These findings indicate a differential development of the limbic systems responsible for incentive and emotional processing, in comparison to top-down control systems, during adolescence when compared to childhood and adulthood (Casey, Jones, & Hare, 2008).
Butane (C4H10), a commonly misused volatile substance readily available in products like lighter fluid, can rapidly permeate the blood-brain barrier due to its nonpolar, hydrophobic, and lipophilic characteristics, with concentration peaks occurring within 1-3 minutes (Kimura-Kataoka et al., 2015).
Resuscitation from cardiac arrest caused by volatile substance abuse, such as butane inhalation, is seldom successful.
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Administering large doses of catecholamines during resuscitation in the presence of butane may lead to recurrent ventricular fibrillation (Edwards & Wenstone, 2000).
An 18-year-old male adolescent, an active smoker, experienced a sudden collapse at home after inhaling butane gas in an attempt to alter his voice. Upon discovery, he was unresponsive and promptly transported to the nearest hospital, which was approximately 10 minutes away. Upon arrival at the emergency department, he was found to be pulseless.
Following the standard advanced cardiovascular life support (ACLS) guidelines, cardiopulmonary resuscitation (CPR) was initiated, continuing for three cycles.
During this time, the patient received 200 joules of unsynchronized shocks from the cardiac monitor, which revealed ventricular fibrillation. Spontaneous circulation was successfully achieved, and the patient was subsequently intubated using rapid sequence intubation.
Subsequent diagnostic tests were conducted, including a chest X-ray, brain computed tomography (CT), and echocardiography, all of which showed no remarkable abnormalities. A complete blood count and various investigations were performed.
The results of metabolic panel, electrolytes, renal panel, and cardiac enzymes were all within normal limits. However, a mild acidosis in the venous blood gas was observed.
Approximately six hours later, the patient was extubated while in the intensive care unit. Upon regaining consciousness, he displayed ataxia, disorientation, and confusion. Consequently, he was referred to another tertiary healthcare facility.
Upon presentation at the tertiary hospital, the patient was vitally stable, but confusion, short-term memory loss, ataxia, and disorientation to time and space persisted. Multiple electrocardiographs were conducted, revealing multiple ST segment abnormalities. A repeat CT brain scan showed no signs of brain insults, and blood investigations remained largely unremarkable.
After assessment by both the cardiologist and neurosurgeon in the Emergency Department, it was decided to admit the patient to the cardiac care unit for rhythm monitoring and further comprehensive evaluations. The patient's neurological deficits were entrusted to a multidisciplinary team.
The following day, a detailed neurological examination by the neurology team confirmed disorientation regarding time and space, short-term memory loss, and ataxia. Magnetic resonance imaging and an electroencephalogram were ordered to differentiate between hypoxic brain injury and toxic brain injury.
By the fourth day, the patient's condition showed significant improvement. He became mobile, able to walk without assistance, conscious, fully oriented, and had regained his memory. No further cardiac or neurological events were recorded during his hospital stay, leading to his subsequent discharge. Follow-up appointments were scheduled for magnetic resonance imaging and electroencephalograms with the neurology clinic (AlRabiah, AlShamrani, & AlMass, 2019).
Butane is a colorless, flammable, and tasteless hydrocarbon gas commonly found in various easily accessible industrial and household products. It is often misused for its euphoric effects (Butane Factsheet - How it’s Misused, n.d.). Studies on experimental animals have investigated the acute toxicity of n-Butane after inhalation exposure (TOXNET, n.d.). Notably, after one hour of inhalation, butane remains relatively unchanged in the blood and organs (Tsukamoto et al., 1985).
The misuse of butane as a volatile agent and intoxication source is well-documented (Erdivanli and Sen, 2015a). Common effects of butane inhalation include headaches, euphoria, vertigo, and relaxation (Kimura-Kataoka et al., 2015). Additionally, butane sensitizes the myocardium to the effects of catecholamines, potentially leading to life-threatening tachyarrhythmias. The surge in catecholamines on the sensitized myocardium may contribute to ventricular fibrillation (Erdivanli and Sen, 2015a). Inhaling butane can also induce cardiac arrhythmias, particularly in cases involving pre-existing heart damage (Erdivanli and Sen, 2015b).
Furthermore, butane inhalation can lead to ST-elevation myocardial infarction, which is not caused by thrombus or emboli in the coronary arteries but rather by vasoconstriction and vasospasms of the coronary arteries (Corbacioglu et al., 2015).
In this case, the patient was a smoker, suggesting that typical adolescent risk-taking behavior may have played a significant role. The act of inhaling butane can be viewed as a manifestation of underdeveloped decision-making processes in the adolescent brain. Volatile substance abuse, such as inhaling chemical compounds to alter mental state, is a common choice among adolescents exhibiting risky behavior.
The adolescent brain undergoes region-specific neurodevelopment, with the prefrontal cortex developing last. The prefrontal cortex is associated with central executive functions and key neurotransmitter systems like dopamine and cholinergic systems. Based on scientific studies, it is evident that the prefrontal cortex primarily functions in temporal organization of behavior, speech, and reasoning.
Interestingly, the prefrontal cortex develops after the limbic system in the brain, responsible for emotions such as fear and anxiety. The maturation of the limbic system before the prefrontal cortex can result in emotions dominating decision-making, as the prefrontal cortex remains underdeveloped (Casey, Jones, and Hare, 2008).
In this case study, it is plausible that the underdeveloped adolescent brain lacked the mature reasoning and cognitive capabilities required to make informed decisions, leading to unintentional self-harm through butane inhalation.
The 18-year-old patient's behavior aligns with typical traits observed in adolescents of his age group. The combination of an underdeveloped adolescent brain and risky behavior, exemplified by the inhalation of the toxic substance butane, resulted in the patient experiencing cardiac arrest due to the surge of catecholamines and vasospasm of the coronary arteries. Notably, the patient's recovery without permanent or long-term damage or death is an uncommon outcome.
Risky Adolescent Behavior and Cardiac Arrest Due to Butane Inhalation. (2024, Jan 24). Retrieved from https://studymoose.com/document/risky-adolescent-behavior-and-cardiac-arrest-due-to-butane-inhalation
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