Treatment of Acute Intoxication From Inhaled 1,2-Difluoroethane

Juan Pablo Arroyo; Daniel C. Johnson; Julia B. Lewis; Ahmed Al Sheyyab; Adam King; Matthew R. Danter; Stuart McGrane; Joshua P. Fessel

doi:10.7326/L18-0186

Letters |4 December 2018

Treatment of Acute Intoxication From Inhaled 1,2-Difluoroethane

Juan Pablo Arroyo, MD, PhD; Daniel C. Johnson, PharmD; Julia B. Lewis, MD; Ahmed Al Sheyyab, MB BS; Adam King, MD; Matthew R. Danter, MD; Stuart McGrane, MB, ChB; Joshua P. Fessel, MD, PhD

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Background: Difluoroethanes are used as refrigerants, foam-blowing agents, solvents, and propellants in various household products. Volatile substances, such as 1,2-difluoroethane, are inhaled for recreational purposes (known as huffing) because they are intoxicating, inexpensive, and easily acquired. When 1,2-difluoroethane is inhaled, it is metabolized to fluoroacetate. This compound complexes with coenzyme A and is metabolized by citrate synthase to form fluorocitrate, which then binds aconitase, blocks the citric acid cycle, and halts energy production (1). Fluorocitrate accumulation in multiple tissues can lead to hypocalcemia. The clinical presentation of 1,2-difluoroethane intoxication varies depending on the dose and the time since exposure. Signs and symptoms range from nausea, vomiting, abdominal pain, diaphoresis, and altered mental status to seizures, fatal arrhythmias, and cardiovascular collapse (2, 3). No reported antidote is available. Current management is limited to supportive care and calcium supplementation.

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