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Fatal Torsade de Pointes Associated with Tetrafluoroethane Inhalation

By Philip S. Mehler, MD, FACP, FAED, CEDS

Burke J, Farastat M, Mehler P, & Krantz, MJ. Fatal Torsade de Pointes Associated with Tetrafluoroethane Inhalation. Clinical Case Reports, 3-07: 1159-1163, 2020.


A patient presented with torsade de pointes after inhaling tetrafluoroethane, a volatile gas propellant used to clean keyboards. She had a prior hospitalization for cardiac arrest without rhythm documentation after inhaling a similar product. Urine toxicology revealed methamphetamine. We are unaware of previous descriptions of torsade de pointes associated with volatile hydrocarbon inhalation or “huffing.” Although sudden death is associated with “huffing,” an arrhythmic mechanism has not been elucidated. Tetrafluoroethane, however, is chemically similar to chlorophorm (trichloromethane), which blocks the delayed rectifier potassium ion current (Ikr). Thus, we postulate that delayed repolarization with methamphetamine triggering may account for this arrhythmia.

Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip S. Mehler began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and then Denver Health’s Chief Medical Officer (CMO) until he was promoted…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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