Critical Care |

A Case of Ultra Duster Intoxication Causing Acute Renal Failure FREE TO VIEW

Danxuan Long, MD; Amina Jaffar, MD; Muhammad Siddique, MD; Joseph Henkle, MD
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Southern Illinois University School of Medicine, Springfield, IL

Chest. 2013;144(4_MeetingAbstracts):290A. doi:10.1378/chest.1703867
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SESSION TITLE: Critical Care Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: 1,1- Difluoroethane is a major component chemical dusters used to clean computers. Duster abuse and its associated toxicity are becoming more common. It is inhaled to induce euphoria. The most common reported cases are mainly sudden death. The other side effect includes prolong QTC, cardiac arrhythmia, dizziness, syncope and acute lung injury. We report the first case of 1,1-Difluoroethane causing acute renal failure.

CASE PRESENTATION: A 37-year-old Caucasian male with past medical history of asthma and shoulder pain on Vicodin was presented to the emergency department after being found unresponsive in a car. The patient had been” huffing” twenty cans of “keyboard cleaner” (Ultra Duster) in the past twenty hours. He huffed it until he passed out for unknown period of time. After the last can he became short of breath, had chest pain and back pain. Abnormal physical exam only include wheezing bilaterally. Laboratory studies revealed leukocytosis with white count of 28 K/cumm; Acute renal failure with Creatinine of 1.8 mg/dL. Drug toxicity shows positive for Marijuana, Cocaine and Opiates. Electrocardiogram shows sinus tachycardia with premature ventricular complexes and prolong QTC at 550 ms. Lactic acid is elevated at 3.2 mmol/L (normal range 0.5-2.2 mmol/L). Chest X-Ray is unremarkable. Patient was treated with IV fluid and steroid for asthma exacerbation. After two days of supportive care, Creatinine improved to 1.4 mg/dL and QTC is down to 432 ms. Patient was discharged home.

DISCUSSION: Computer duster has been increasingly abused and intoxications are being presented more frequently to emergency departments across the United States. Bitterant is usually added to discourage inhalant abuse but it is still commonly abused by adolescents and teens due to its easy accessibility. This is the first case of Duster causing acute renal failure, presumably secondary to dehydration since Creatinine did improve with IV fluid. However, we cannot rule out the possibility of direct toxic effect of Duster on the kidney. The patient also has prolong QTC which resolved with supportive treatment.

CONCLUSIONS: Conclusion: With the increasing abuse of Duster, clinicians should be cognizant of potential toxicities which include sudden death, prolong QTC, cardiac arrhythmia, syncope, acute lung injury and acute renal failure.

Reference #1: http://www.ultraduster.com/msds/ultra-duster.html

Reference #2: 1,1-Difluoroethane National Library of Medicine HSDB Database

DISCLOSURE: The following authors have nothing to disclose: Danxuan Long, Amina Jaffar, Muhammad Siddique, Joseph Henkle

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