Asphyxiation by Cake: An Unusual Case of Dyspnea

Other case presentations
Similar cases have been described in the literature. In one case, following Hurricane Ivan, a 34-year-old man placed four 25-pound blocks of dry ice wrapped in paper in the front seat of his truck with the windows closed.⁵ After driving less than one-quarter of a mile, he developed dyspnea and telephoned for help before losing consciousness. Fortunately, he was found in time and recovered soon after the doors to his truck were opened.⁵

In another case, a 59-year-old man entered a walk-in freezer that contained dry ice wrapped loosely in plastic. He was found inside the freezer 20 minutes later in cardiac arrest; resuscitation efforts were unsuccessful. Investigation of the freezer found an initial O₂ concentration of 13% (normal level, 20.93%) and an estimated CO₂ level of 40%.⁵

Similarly, a 35-year-old woman was inadvertently locked in a bank vault while storing receipts. In a bid for help, she pulled the fire alarm, which triggered a CO₂-based fire-extinguishing system. The fire department responded and found the woman dead in the vault 30 minutes later. The cause of death was labeled as CO₂ intoxication.⁶

Natural phenomena
There have also been documented cases of CO₂ toxicity associated with volcanic eruption and other natural phenomena; for example, the Lake Nyos, Cameroon, West Africa incident in 1986. In this event, a magma pocket underlying the lake saturated the water with CO₂ stored as carbonic acid in the water. When a landslide hit the lake, it caused the carbonic acid stored in the depths of the lake to be upheaved to the surface, where it turned back into CO₂ and was released into the atmosphere. Since CO₂ is heavier than O₂, it displaced the O₂ near the ground, resulting in the suffocation and death of 1,700 people in the surrounding villages.²

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