Je prezentován případ smrtelné otravy mladé ženy butanem. Kvantitativní toxikologickou analýzou byla stanovena koncentrace butanu 6,8 μl/ml v krvi z femorální žíly, dále byl detekován také isobutan a propan. Byl pozorován výrazný edém plicní a depozita lipofuscinu v myokardu. Stanovili jsme, že příčinou smrti oběti byla srdeční arytmie způsobená abúzem butanu.
Klíčová slova: butan – srdeční toxicita – otrava
Naoko Tanaka1; Hiroshi Kinoshita1; Reiji Haba2; Mostofa Jamal1; Eriko Ohkubo1; Kiyoshi Ameno1
Authors place of work:
Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, 761-0793, Japan1; Department of Surgical Pathology, Kagawa University Hospital, 1750-1 Miki, Kagawa, 761-0793, Japan2
Published in the journal:
Soud Lék., 55, 2010, No. 4, p. 44-45
A case of fatal butane gas poisoning in a young female is presented. Quantitative toxicological analysis showed that the concentration of butane in the femoral blood was 6.8 μl/ml, and isobutane and propane were also identified. Severe congestion of the lungs and deposition of lipofuscin in the myocardium were also observed. We concluded that the cause of death of the victim was due to cardiac arrhythmia induced by the butane gas abuse.
Key words: butane – cardiac toxicity – poisoning
a low molecular weight aliphatic hydrocarbon, is a colorless and
flammable gas used commercially as a fuel source and/or a propellant
. It is usually mixed with n-propane and isobutane to produce
a commercially available fuel . In case of gas abuse, the cause of
death may be due to asphyxia, vagal inhibition, respiratory depression or
cardiac arrhythmia [2, 10]. Here we report a case of death caused by
inhalation of a gas containing n-butane, with lipofuscin accumulation in
female (height 160 cm, weight 64 kg) suddenly collapsed after getting out of
her friend’s car, and was then transferred to the hospital. She was in
cardiopulmonary arrest at the time of arrival at the hospital, and
resuscitation attempts were unsuccessful. Three bottles of empty gas canisters
were found near her seat during the subsequent investigation by the
authorities. The main component of the gas was n-butane. She had a history
of volatile gas abuse over the past few years. Her friend stated that she had
been sprayed the gas directly into her throat in his car over the previous few
revealed that slight contusion of the forehead was observed as external injury.
The heart weighed 285 g containing 200 ml of blood without coagula,
and the brain weighed 1200 g, neither having any abnormal findings. The left and
right lungs weighed 558 and 746 g, respectively, and were severely congested.
The trachea was filled with a reddish frothy fluid. The stomach contained
approximately 180 ml of foodstuffs. Histological examination revealed
moderate fragmentation of the myocardium (Figure 1) and Schmorl’s staining
showed a large number of lipofuscin deposits around the nucleus of the
myocardium (Figure 2). The lungs showed marked congestion and edema with
alveolar hemorrhage (Figure 3).
Drug screening test using a TriageTM
(Biosite Diagnostic Inc, San Diego, USA) panel was negative. No ethanol was
detected by gas chromatography. Postmortem blood sample was collected in
a sealed vial  for toxicological examination and kept at -70°C
until analysis. Toxicological analysis was performed using a gas
chromatography-mass spectrometry, and the concentration of n-butane was
determined by head-space gas chromatography, according to the method of Ago et
Results and Discussion
n-butane, isobutane and n-propane were identified by the toxicological
examination. The concentration of butane in the victim’s femoral blood was 6.8 μl/ml. This concentration was within the range of the
previous reported fatal cases [1, 6, 8, 12]. In fatal cases of inhalation of
gases contained n-butane, the most common cause of death is cardiac arrhythmia
due to sensitization of the heart to adrenaline [9, 10]. From the autopsy
findings, histological findings and the results of the toxicological
examination, we concluded that the cause of death was cardiac arrhythmia due to
butane gas abuse. Histological findings, such as the focal fragmentation of the
myocardium and pulmonary edema with alveolar hemorrhage may support this
conclusion. As she had not used plastic bag for inhalation, and there were no
findings of aspiration of the vomitus in the present case, we speculate that
acute asphyxia was less of a contributing factor to this fatality.
Histological study of the myocardium showed lipofuscin
accumulation. There is no report of a relationship between the inhalation
of butane and lipofuscin accumulation. Lipofuscin is a yellow-brown
pigment composed of lipid and protein residues, which accumulates progressively
in the normal aging process in postmitotic cells such as cardiomyocyte and
neurons [4, 5, 11]. However, because the deceased was only in her twenties with
no past histories, large numbers of lipofuscin pigmentation is not normal
findings in the present case.
formation of lipofuscin is also involved in oxidative stress and autophagy .
Oxidative macromolecular damage accumulates by normal mitochondrial respiration
as an age-related change . Autophagy is responsible for the
lipofuscinogenesis in the heart , which is a cellular process
responsible for the removal or recycling of long-lived protein and organelles
via lysosomal degradation. We speculate that the increase of the lipofuscin
accumulation in the heart may be the result of the impairment of autophagy in
cardiomyocytes caused by butane abuse.
Autophagy is essential for cellular homeostasis in the
heart, maintaining cardiac structure and function , and is involved in the
pathophysiology of various kinds of diseases, such as cardiac hypertrophy,
cardiomyopathies, ischemia and reperfusion [5,13]. Alterations of autophagy
occur in various pathological conditions . However, the function of
autophagy is not completely understood, and it may have both protective and
detrimental roles . Butane abuse may be associated with autophagy by as yet
unknown mechanisms. The impairment of autophagy
may induce cardiac dysfunction. Further studies will be required to clarify
these relationships. The present case indicates that we should pay more
attention to cardiac toxicity in case of repeated use of volatile substances.
Department of Forensic Medicine, Faculty of
Medicine, Kagawa University,
1750-1, Miki, Kita, Kagawa, 761-0793, Japan
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