SESSION TITLE: Poisoning and Drug Overdose 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Gasses such as nitrogen, helium, and argon are considered to be non-toxic and benign due to their inert nature. They are colorless, odorless gasses that are rarely reported to cause injury. However, the following case demonstrates the indolent ability of inert gasses to cause significant harm with minimal warning. CASE PRESENTATION: A 50-year-old female presented to the emergency department with shortness of breath, altered mental status, and burns. She had a pulse of 100 bpm, respiratory rate of 26, blood pressure of 170/116, and SaO2 of 100%. On physical examination, she was making incomprehensible sounds, not following commands, and opening her eyes spontaneously. Cold burns were reported over 30% of her body. She was subsequently intubated and infused with warm IV fluids. Chest x-ray revealed no acute cardiopulmonary processes, and carboxyhemoglobin levels were normal. She was an employee at a local sperm bank who was found collapsed on the ground while attempting to correct a liquid nitrogen leak. She was later transferred to the burn unit for management of her liquid nitrogen cryoinjuries. A police officer who attempted to rescue this employee succumbed to inhalation of the gas, while three other officers were treated with symptoms of shortness of breath and have since recovered. DISCUSSION: Inert gasses stored in a liquid state at high pressure such as nitrogen are capable of rapidly expanding at atmospheric pressure and temperature. Liquid nitrogen expands to 694 times its original volume at 1 atm and 20°C. Although ambient air contains 78% nitrogen, the rapid expansion can quickly displace oxygen in enclosed spaces with poor ventilation. Given that exchange of CO2 continues to occur freely, there is no hypercapnic response elicited by medullary chemoreceptors that would evoke the traumatic sensation of suffocation. The oxygen chemoreceptors do not have a significant response to hypoxemia until PaO2 reaches below 55 mmHg. An individual may experience loss of consciousness and subsequent death with few to no warning symptoms. The patients in this case were subjected to oxygen levels that reached 0.2% because of a liquid nitrogen leak at the sperm bank. At medical facilities, large amounts of liquid nitrogen are frequently stored for laboratory work and research. Nitrogen gas asphyxiation has been reported to occur about eight times per year with many of the fatalities from attempted rescues. CONCLUSIONS: Inert gasses such as liquid nitrogen are often disregarded as hazards. However, those who handle them should be aware of the potential danger of the rapid displacement of oxygen in enclosed spaces. Reference #1: Hazards of Nitrogen Asphyxiation. U.S. Chemical Safety and Hazard Investigation Board. 2006; No. 2003-10-B. Reference #2: Kim V, et al. Oxygen Therapy in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc. 2008; 5(4): 513-518. Reference #3: “Regulation of Respiration.” Hall JE, Guyton AC. Guyton and Hall Textbook of Medical Physiology. Philadelphia: Elsevier; 2016. DISCLOSURE: The following authors have nothing to disclose: Ivan Morales, Jayanth Keshavamurthy, Nikhil Patel, Norman Thomson No Product/Research Disclosure Information