Ethyl chloride poisoning from inhalational misuse: clinical features and outcomes

Ethyl chloride misuse remains a prevailing concern due to its accessibility, but detailed descriptions of the features of toxicity are limited to sporadic reports, resulting in knowledge gaps in their clinical features and diagnosis.

To describe the clinical features, treatment, and outcomes of patients reported in the literature who developed toxicity from inhalational use of ethyl chloride.

We reviewed relevant literature over the past 50 years and analyzed the characteristics and outcomes of patients with toxicity from the inhalational use of ethyl chloride.

A total of 21 studies from 1979 to 2024 were identified, making available 22 patients for analysis. Their median age was 40 years (range 16-62 years), and there were more than four times as many males as females. Ethyl chloride-containing cleaning solvents (8/22, 36%) were most commonly used. Regular inhalation of ethyl chloride was documented in approximately two-thirds of the patients (14/22, 66%), with a median duration of five months of misuse (range 2-360 months). A large proportion of patients (15/22, 68%) inhaled ethyl chloride again within a week from the onset of toxicity. Although features of cerebellar dysfunction were very common at presentation (13/16, 81%), abnormalities on neuroimaging studies were rare. Death occurred in more than a quarter of cases (6/22, 27%), with patients either already deceased or dying shortly after. Half (3/6) of these deaths were directly attributable to the development of lethal cardiac dysrhythmias. Conversely, most survivors either improved or fully recovered within a few days to weeks (14/16, 88%), independent of their presenting symptoms, clinical signs, and the treatments they received.

Ethyl chloride users are likely young or middle-aged males, and clinical features of toxicity can range from transient neurological symptoms to cardiac dysrhythmias and death. The prominence of neurotoxicity may be attributed to the lipophilic nature of ethyl chloride and its tendency to accumulate in neural tissue, while cardiac dysrhythmias have been attributed to cardiac sensitization to catecholamines through ethyl chloride-induced inhibition of potassium, calcium, and sodium channels.

Toxicity from the inhalational misuse of ethyl chloride should be considered in young or middle-aged males presenting with acute cerebellar dysfunction. We recommend that suspected cases undergo telemetric monitoring for 24 h, especially when tachycardia and/or palpitations are present, as deaths from lethal cardiac dysrhythmias are not uncommon.