Death due to inhalants can occur as a consequence of several mechanisms, including sudden sniffing death syndrome, suffocation, dangerous behavior and aspiration. In 1970 Bass described sudden sniffing death syndrome. Typically, the user is suddenly stimulated, rises to run, collapses and suddenly dies. The stimulation may be the result of being discovered in the act by a person of authority, or of a particularly moving hallucination. The pathogenesis is as follows.
Inhalants sensitize the myocardium to the effects of epinephrine.
The acute stimulus results in an abrupt secretion of epinephrine, and the sensitized myocardium responds with ventricular fibrillation. Suffocation can occur if a plastic bag is used for the delivery of the inhalant. If the user passes out, the bag can collapse and cover both the nose and the mouth. Death due to dangerous behavior is a consequence of the disinhibition and poor judgment while under the influence of inhalants with death resulting from falls, fires and drownings. If the user should vomit, aspiration is a risk because of compromise of upper airway reflexes.