- Email: [email protected]
Burns following petrol sniffing
Copyright
0 1997 Elsevier
ELSEVIER
Bums Vol. 23, No. 1, pp. 78-80, 1997 Science Ltd for ISBI. All rights reserved Printed in Great Britain 0305-4179/97 $17.00 + 0.00
PII: SO305-4179(96)00070-8
Burns following
petrol
sniffing
T. F. Jane22 Burns Unit, Department
of Plastic Surgery and Burns, Clinical Centre Ljubljana,
Tzuo patients with burns following petrol snifj2’ng are presented. They sustained an 8 per cent and a 70 per cent total body surface area burn. The majority of the burned areas of both patients were full thickness and were treated by early excision and autografting, and in oozepatied with culturedepidermal autografts also. Both patients came from disorganized families, had bekauioural problems and poor school performance. Clothes soaked with petrol, altered mental stai’e and cigarette smoking are major risk factors for thermal injury while inhaling petrol. In order to recognize acute and ckronic intoxicalion, burns unit staff should be aware of the clinical signs related to inhalation of petrol, especially because some of the burned petrol sniffers might not admit to petrol abuse. The s:ocial wo-fker and psychologist are very likely to be vital in the rehabilitation of suck patients. 0 1997 Elsevier Science Ltd for ISBI. All rigkts reserved.
Burns, Vol. 23, No. 1, 78-80, 1997
Introduction In 1941 Machle published a review of petrol intoxication where he mentioned that some persons inhaled it intentionally in order to achieve pleasurable effectsl. Fifteen to 20 breaths may be sufficient to produce euphoria, ataxia and disorientation, lasting 5 or 6 h2. Large numbers of reports in regard to epidemiology, prevention, acute and chronic intoxication of petrol sniffing have been published3-9. This paper reports two patients who sustained thermal
injury
sniffing petrol. been inhaling
on two
separate occasions while
They both admitted petrol
that they had
fumes at the time of the
Ljubljana,
Slovenia
thickness burn on his lower leg (6 per cent) was treated with early tangential excision and auto split-thicknessskin grafts. His postoperativerecovery was uneventful. Patient D.M., aged 16 years, sustained a 70 per cent TBSA burn while sniffing petrol from a 5-litre canister.He and three other boys were also smoking cigarettes and drin.king alcohol. The accident happened in a deserted mine shaft early in the evening. His petrol-soaked clothes were set on fire accidentally by a cigarette. The patient’s 65 per cent TBSA full-thickness burn were treated by early fascial excision, auto skin grafts, glycerol-preserved cadaveric skin and cultured epidermal autografts. He was fully healed in 80 days and has up to now undergone several reconstructive procedures for laite sequelaeof the burn (Figure2). At the time of admissionboth patients had no neurological abnormalities. They claimed that they had sniffed petrol only several times, therefore noI further investigations with regard to lead intoxications were done. The social background was similar for both patients. They came from socially disorganized fnmilies with inadequa.te father figures and had behavioural problems with poor school performance. The parents of both patients lived separately. Patient D.M. lived with his aunt and patient H.E. with his single mother. Such a social background has been already recognizeNd as a predisposing factor for petrol abuse’“,*l.However the:ir familieswere not poor and did not come from an ethnic minority with a cultural crisis. The socialworker and psychologistwere involved in the rehabilitation of both youths. A year after the burn patient H.E. denied further volatile substanceabuse. His social circumstancesdid not change. Patient 13.M. deniesfurther petrol sniffing, he is keen to start at grammar school this year and his famili has started living together.
accident.
Discussion Case reports Patient H.E. aged 15 years sustained an 8 per cent TBSA burn of the lower leg, both hands and one forearm while sniffing petrol :from a motorbike tank. A cloth soaked in; petrol was used. The accident happened on the street late in the night. He was accompaniedby two other boys. One of them accidentally lit his petrol-soaked clothes with a cigarette. The patient denied alcohol or drug abuse.A full-
No national data on prevalence of volatile substance abuse in Slovenia are available. Furthermore, there are no figures obtainable for the prevalence of petrol sniffing. The Ljubljana Burns Unit covers a population of about 1400000, which is approximately two-thirds of the Slovenian population. The two patients presented are the only patients with positive anamnesis with regard to petrol sniffing admitted to
Janeii?:
Burns following
petrol
sniffing
79
Ljubljana Burns Unit in 10 years out of 4000 admissions in that period. It is very likely that these two cases may reflect a rise in prevalence of petrol sniffing in this country. The abuse of volatile substances has never been against the law in Slovenia therefore one would expect that burned petrol sniffers would not be reluctant to admit to petrol sniffing. Both patients reported had been sniffing leaded petrol. Leaded petrol is a mixture of C4 to Cl2 aliphatic hydrocarbons. The precise composition may vary widely. All of the saturated hydrocarbons in the C4 to C8 range have strong narcotic propertie@. N-Hexane, a component of petrol, is known to be a peripheral neurotoxirP. Tetraethyl lead (TEL) is added to leaded petrol as an anti-knock agent. Its concentration varies among brands but a concentration of 0.4-0.76 g per litre has been cited13m15. Most of the toxic effects in chronic petrol sniffers are thought to be due to TEL and its metabolitesll. TEL produces organolead poisoning which differs from classical elemental lead poisoning. It is known that chronic petrol sniffing produces encephalopathy with dis-
orientation and hallucinations7,10,which may be progressive and fataP. Acute myopathy’“, myoclonus’5 and peripheral neuropathy17 have also been reported in association with petrol sniffing. Petrol sniffing presents also a major predisposing factor for thermal injury. Usually a rag soaked in petrol is used, often some of the petrol is poured on to the clothes of the sniffer. Sniffing is frequently associated with alcohol abuse and both alter the mental state substantially. Smoking cigarettes usually accompanies the activity. Burned patients may deny sniffing petrol when admitted to a burns unit because it is socially unacceptable. Burns unit staff should know the epidemiology, social background and clinical manifestations of chronic petrol sniffing, especially if the burned patient denies it. Chelation therapy is important in the management of chronic petrol sniffers who are intoxicated with lead’*. It is generally agreed that petrol sniffing is a manifestation of basic social, psychological and cultural malaisell. Petrol sniffing has been mainly reported to be highly prevalent in closed native communities of northern Canada, Australia and southern USA3,“r7, who differ entirely in cultural background to Slovenia. Measures should be taken to prevent continuing petrol abuse. Young people should be made more aware of the toxic effects of chronic petrol abuse. The high possibility and consequences of extensive and deep burns following inhalation of petrol should be clearly presented to young adolescents.
References 1 Machle W. Gasolene intoxication. JAMA 1941; 117: 1965-1971. 2 Poklis A, Burkett CG. Gasolene sniffing: a review. Clin Toxical 1977; 11: 35-41. 3 Bryce S, Rowse T, Scrimgeour D. Evaluating the petrolsniffing prevention programs of the Healthy Aboriginal Life Team (HALT). Aust J Public Health 1992; 16: 387-396. 4 Remington G, Hoffman BF. Gas sniffing as a form of substance abuse. Can J Psyckiatu~ 1984; 29: 31-35. 5 Edminster SC, Bayer MJ. Recreational gasoline sniffing: acute gasoline intoxication and latent organolead poisoning. Case reports and literature review. J Emerg Med
1985; 3: 365-370. JD. Gasoline sniffing. Am J Med 1985; 79: 6 Fortenberry 740-744. JL, Hirsch. W, Brillman J et al. Gasoline sniffing 7 Coulehan and lead toxicity in Navajo adolescents. Pediatrics 1983; 71:
Figure
1. Patient
reconstructive
D.M. procedures
7 months have
after already
the accident (several been undertaken).
113-117. 8 Kaelan C, Harper C, Vieira BI. Acute encephalopathy and death due to petrol sniffing: neuropathological findings. Aust NZ J Med 1986; 16: 804-807. 9 Poklis A. Death resulting from gasoline ‘sniffing’: a case report. J Forens Sci Sot 1976; 16: 43-46. 10 Moss MA, Cooper PJ. Gasoline sniffing and lead poisoning. Acfa Pkarmacol Toxicol 1986; 59: (suppl 7), 48-51. 11 Ross CA. Gasoline sniffing and lead encephalopathy. Can
Med Assoc J 1982; 127: 1195-1197.
Burns: Vol. 23, No. 1,1997
80 12 Tenenbein M, deGroot W, Rajani KR. Peripheral neuropathy following intentional inhalation of naphtha fumes. Can Med Assoc J 1984; 131:1077-1079. 13 Boeckx RL, Post1 B, Coodin FJ. Gasoline sniffing and tetraethyl lead poisoning in children. Pediatrics 1977; 60: 140-145. 14 Kovanen J, Somer H, Schroeder P. Acute myopathy associated with gasoline sniffing. &urology 1983; 33: 629-631. 25 Hansen KS, Sharp FR. Gasoline sniffing, lead poisoning, and myoclonus. JAMA 1978; 240: 1375-1376. 16 Valpey R, Sumi SM, Copass MK, Goble GJ. Acute and chronic progressive encephalopathy due to gasoline sniffing. Ne~vology 1978; 28: 507-510.
EUROPEAN
17 Gallassi R, Montagna P, Pazzaglia P, Cirignotta F, Lugaresi E. Peripheral neuropathy due to gasoline sniffing - a case report. Eur AJeuroll980; 19:419-421. 18 Seshia SS, Rjani KR, Boeckx RL, Chow PN. The neurological manifestations of chronic inhalation of leaded gasoline. Dev Med Child Neural 1978;20:323-334.
Paper accepted 1 July 1996. Correspondence should be addressed to: T. F. JaneBiT, Burns Unit, Department of Plastic Surgery and Burns, Clinical Centre Ljubljana, ZaloSka 7, 1525 Ljubljana, Slovenia.
BURNS ASSOCIATION
7th International Congress With Belgian Association for Burn Injuries 1%20/09/97, LEUVEN, BELGIUM Congress idormation Congress Venue
University Research Auditoria Herestraat
Hospital Gasthuisberg and Development (Onderwijs GAl, GA2, GA.3 49, 3000 Leuven, Belgium
Congress Dates
Thursday September
Congress Language
English. There will be no simultaneous
Congress Secretariat
W. D. Boeckx, M.D., Ph.D., Local Organizer Burns Unit, University Hospital Gasthuisberg,
Before meeting
Phone +32/16/34.87.21 Fax +32/16/34.87.23
During meeting
Phone +32/16/34.59.21 Fax +32/16/23.18.43
mportant
l&l997
en Navorsing)
- Saturday September 20,1997 translation Herestraat 49,300O Leuven, Belgium
dates
March 15, 1997: Deadline for the Submission of Abstract. January 31, 1997: Deadline for Early Registration. June 30, 1997: Deadline for Registration at Normal Rate. June 30, 1997: Deadline for Guaranteed Hotel Accommodation. Wednesday September 17, 1997: E.B.A. Executive Committee Meeting, 14.00. Preconference Practical Workhop: Silicone and Pressure Therapy. September 18 until September 20, 1997: E.B.A. Congress, 5th International Conference on the psychiatric, psychologic and social care of the burn patient. Thursday September 18, 1997, 18.00: Welcome Reception. Thursday September 18, 1997, 16.00: General Assembly. Friday September 19, 1997, 20.00: Congress Banquet.
0 1997 Elsevier
ELSEVIER
Bums Vol. 23, No. 1, pp. 78-80, 1997 Science Ltd for ISBI. All rights reserved Printed in Great Britain 0305-4179/97 $17.00 + 0.00
PII: SO305-4179(96)00070-8
Burns following
petrol
sniffing
T. F. Jane22 Burns Unit, Department
of Plastic Surgery and Burns, Clinical Centre Ljubljana,
Tzuo patients with burns following petrol snifj2’ng are presented. They sustained an 8 per cent and a 70 per cent total body surface area burn. The majority of the burned areas of both patients were full thickness and were treated by early excision and autografting, and in oozepatied with culturedepidermal autografts also. Both patients came from disorganized families, had bekauioural problems and poor school performance. Clothes soaked with petrol, altered mental stai’e and cigarette smoking are major risk factors for thermal injury while inhaling petrol. In order to recognize acute and ckronic intoxicalion, burns unit staff should be aware of the clinical signs related to inhalation of petrol, especially because some of the burned petrol sniffers might not admit to petrol abuse. The s:ocial wo-fker and psychologist are very likely to be vital in the rehabilitation of suck patients. 0 1997 Elsevier Science Ltd for ISBI. All rigkts reserved.
Burns, Vol. 23, No. 1, 78-80, 1997
Introduction In 1941 Machle published a review of petrol intoxication where he mentioned that some persons inhaled it intentionally in order to achieve pleasurable effectsl. Fifteen to 20 breaths may be sufficient to produce euphoria, ataxia and disorientation, lasting 5 or 6 h2. Large numbers of reports in regard to epidemiology, prevention, acute and chronic intoxication of petrol sniffing have been published3-9. This paper reports two patients who sustained thermal
injury
sniffing petrol. been inhaling
on two
separate occasions while
They both admitted petrol
that they had
fumes at the time of the
Ljubljana,
Slovenia
thickness burn on his lower leg (6 per cent) was treated with early tangential excision and auto split-thicknessskin grafts. His postoperativerecovery was uneventful. Patient D.M., aged 16 years, sustained a 70 per cent TBSA burn while sniffing petrol from a 5-litre canister.He and three other boys were also smoking cigarettes and drin.king alcohol. The accident happened in a deserted mine shaft early in the evening. His petrol-soaked clothes were set on fire accidentally by a cigarette. The patient’s 65 per cent TBSA full-thickness burn were treated by early fascial excision, auto skin grafts, glycerol-preserved cadaveric skin and cultured epidermal autografts. He was fully healed in 80 days and has up to now undergone several reconstructive procedures for laite sequelaeof the burn (Figure2). At the time of admissionboth patients had no neurological abnormalities. They claimed that they had sniffed petrol only several times, therefore noI further investigations with regard to lead intoxications were done. The social background was similar for both patients. They came from socially disorganized fnmilies with inadequa.te father figures and had behavioural problems with poor school performance. The parents of both patients lived separately. Patient D.M. lived with his aunt and patient H.E. with his single mother. Such a social background has been already recognizeNd as a predisposing factor for petrol abuse’“,*l.However the:ir familieswere not poor and did not come from an ethnic minority with a cultural crisis. The socialworker and psychologistwere involved in the rehabilitation of both youths. A year after the burn patient H.E. denied further volatile substanceabuse. His social circumstancesdid not change. Patient 13.M. deniesfurther petrol sniffing, he is keen to start at grammar school this year and his famili has started living together.
accident.
Discussion Case reports Patient H.E. aged 15 years sustained an 8 per cent TBSA burn of the lower leg, both hands and one forearm while sniffing petrol :from a motorbike tank. A cloth soaked in; petrol was used. The accident happened on the street late in the night. He was accompaniedby two other boys. One of them accidentally lit his petrol-soaked clothes with a cigarette. The patient denied alcohol or drug abuse.A full-
No national data on prevalence of volatile substance abuse in Slovenia are available. Furthermore, there are no figures obtainable for the prevalence of petrol sniffing. The Ljubljana Burns Unit covers a population of about 1400000, which is approximately two-thirds of the Slovenian population. The two patients presented are the only patients with positive anamnesis with regard to petrol sniffing admitted to
Janeii?:
Burns following
petrol
sniffing
79
Ljubljana Burns Unit in 10 years out of 4000 admissions in that period. It is very likely that these two cases may reflect a rise in prevalence of petrol sniffing in this country. The abuse of volatile substances has never been against the law in Slovenia therefore one would expect that burned petrol sniffers would not be reluctant to admit to petrol sniffing. Both patients reported had been sniffing leaded petrol. Leaded petrol is a mixture of C4 to Cl2 aliphatic hydrocarbons. The precise composition may vary widely. All of the saturated hydrocarbons in the C4 to C8 range have strong narcotic propertie@. N-Hexane, a component of petrol, is known to be a peripheral neurotoxirP. Tetraethyl lead (TEL) is added to leaded petrol as an anti-knock agent. Its concentration varies among brands but a concentration of 0.4-0.76 g per litre has been cited13m15. Most of the toxic effects in chronic petrol sniffers are thought to be due to TEL and its metabolitesll. TEL produces organolead poisoning which differs from classical elemental lead poisoning. It is known that chronic petrol sniffing produces encephalopathy with dis-
orientation and hallucinations7,10,which may be progressive and fataP. Acute myopathy’“, myoclonus’5 and peripheral neuropathy17 have also been reported in association with petrol sniffing. Petrol sniffing presents also a major predisposing factor for thermal injury. Usually a rag soaked in petrol is used, often some of the petrol is poured on to the clothes of the sniffer. Sniffing is frequently associated with alcohol abuse and both alter the mental state substantially. Smoking cigarettes usually accompanies the activity. Burned patients may deny sniffing petrol when admitted to a burns unit because it is socially unacceptable. Burns unit staff should know the epidemiology, social background and clinical manifestations of chronic petrol sniffing, especially if the burned patient denies it. Chelation therapy is important in the management of chronic petrol sniffers who are intoxicated with lead’*. It is generally agreed that petrol sniffing is a manifestation of basic social, psychological and cultural malaisell. Petrol sniffing has been mainly reported to be highly prevalent in closed native communities of northern Canada, Australia and southern USA3,“r7, who differ entirely in cultural background to Slovenia. Measures should be taken to prevent continuing petrol abuse. Young people should be made more aware of the toxic effects of chronic petrol abuse. The high possibility and consequences of extensive and deep burns following inhalation of petrol should be clearly presented to young adolescents.
References 1 Machle W. Gasolene intoxication. JAMA 1941; 117: 1965-1971. 2 Poklis A, Burkett CG. Gasolene sniffing: a review. Clin Toxical 1977; 11: 35-41. 3 Bryce S, Rowse T, Scrimgeour D. Evaluating the petrolsniffing prevention programs of the Healthy Aboriginal Life Team (HALT). Aust J Public Health 1992; 16: 387-396. 4 Remington G, Hoffman BF. Gas sniffing as a form of substance abuse. Can J Psyckiatu~ 1984; 29: 31-35. 5 Edminster SC, Bayer MJ. Recreational gasoline sniffing: acute gasoline intoxication and latent organolead poisoning. Case reports and literature review. J Emerg Med
1985; 3: 365-370. JD. Gasoline sniffing. Am J Med 1985; 79: 6 Fortenberry 740-744. JL, Hirsch. W, Brillman J et al. Gasoline sniffing 7 Coulehan and lead toxicity in Navajo adolescents. Pediatrics 1983; 71:
Figure
1. Patient
reconstructive
D.M. procedures
7 months have
after already
the accident (several been undertaken).
113-117. 8 Kaelan C, Harper C, Vieira BI. Acute encephalopathy and death due to petrol sniffing: neuropathological findings. Aust NZ J Med 1986; 16: 804-807. 9 Poklis A. Death resulting from gasoline ‘sniffing’: a case report. J Forens Sci Sot 1976; 16: 43-46. 10 Moss MA, Cooper PJ. Gasoline sniffing and lead poisoning. Acfa Pkarmacol Toxicol 1986; 59: (suppl 7), 48-51. 11 Ross CA. Gasoline sniffing and lead encephalopathy. Can
Med Assoc J 1982; 127: 1195-1197.
Burns: Vol. 23, No. 1,1997
80 12 Tenenbein M, deGroot W, Rajani KR. Peripheral neuropathy following intentional inhalation of naphtha fumes. Can Med Assoc J 1984; 131:1077-1079. 13 Boeckx RL, Post1 B, Coodin FJ. Gasoline sniffing and tetraethyl lead poisoning in children. Pediatrics 1977; 60: 140-145. 14 Kovanen J, Somer H, Schroeder P. Acute myopathy associated with gasoline sniffing. &urology 1983; 33: 629-631. 25 Hansen KS, Sharp FR. Gasoline sniffing, lead poisoning, and myoclonus. JAMA 1978; 240: 1375-1376. 16 Valpey R, Sumi SM, Copass MK, Goble GJ. Acute and chronic progressive encephalopathy due to gasoline sniffing. Ne~vology 1978; 28: 507-510.
EUROPEAN
17 Gallassi R, Montagna P, Pazzaglia P, Cirignotta F, Lugaresi E. Peripheral neuropathy due to gasoline sniffing - a case report. Eur AJeuroll980; 19:419-421. 18 Seshia SS, Rjani KR, Boeckx RL, Chow PN. The neurological manifestations of chronic inhalation of leaded gasoline. Dev Med Child Neural 1978;20:323-334.
Paper accepted 1 July 1996. Correspondence should be addressed to: T. F. JaneBiT, Burns Unit, Department of Plastic Surgery and Burns, Clinical Centre Ljubljana, ZaloSka 7, 1525 Ljubljana, Slovenia.
BURNS ASSOCIATION
7th International Congress With Belgian Association for Burn Injuries 1%20/09/97, LEUVEN, BELGIUM Congress idormation Congress Venue
University Research Auditoria Herestraat
Hospital Gasthuisberg and Development (Onderwijs GAl, GA2, GA.3 49, 3000 Leuven, Belgium
Congress Dates
Thursday September
Congress Language
English. There will be no simultaneous
Congress Secretariat
W. D. Boeckx, M.D., Ph.D., Local Organizer Burns Unit, University Hospital Gasthuisberg,
Before meeting
Phone +32/16/34.87.21 Fax +32/16/34.87.23
During meeting
Phone +32/16/34.59.21 Fax +32/16/23.18.43
mportant
l&l997
en Navorsing)
- Saturday September 20,1997 translation Herestraat 49,300O Leuven, Belgium
dates
March 15, 1997: Deadline for the Submission of Abstract. January 31, 1997: Deadline for Early Registration. June 30, 1997: Deadline for Registration at Normal Rate. June 30, 1997: Deadline for Guaranteed Hotel Accommodation. Wednesday September 17, 1997: E.B.A. Executive Committee Meeting, 14.00. Preconference Practical Workhop: Silicone and Pressure Therapy. September 18 until September 20, 1997: E.B.A. Congress, 5th International Conference on the psychiatric, psychologic and social care of the burn patient. Thursday September 18, 1997, 18.00: Welcome Reception. Thursday September 18, 1997, 16.00: General Assembly. Friday September 19, 1997, 20.00: Congress Banquet.