Inhalant abuse: Difference between revisions
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==Background== | ==Background== | ||
* | *First described in the 1950s | ||
* | *Most common abusant in preteens 11-13yo | ||
* | *Most abused: gasoline, solvents like toluene, spray paints, lighter fluid, air fresheners, glue, and electronic cleaners (halogenated hydrocarbons) | ||
* | *Includes: "sniffing", "huffing", "bagging", and "dusting" | ||
==Clinical Features== | ==Clinical Features== | ||
* | *General: Euphoria, hallucinations | ||
* | *Neuro: Impaired motor activity, ataxia, depressed mentation, withdrawal potential | ||
* | *Cardiac: Widened QRS, prolonged QT, syncope, arrhythmias | ||
* | *Skin: May cause dermal burns | ||
* " | *"Sudden sniffing death" - thought to be occur with sudden catecholamine surge on a "sensitized" myocardium | ||
*Other: | |||
**[[Rhabdomyolysis]], [[acute kidney injury]] | |||
**Secondary [[renal tubular acidosis]] | |||
**[[Hypokalemia]] | |||
**[[Metabolic acidosis]] | |||
**[[Hepatitis]], hepatic failure | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Drugs of abuse types}} | {{Drugs of abuse types}} | ||
{{Toxic gas exposure DDX}} | |||
== | ==Evaluation== | ||
*Generally a clinical diagnosis | |||
*[[ECG]] | |||
*Consider CT head | |||
*[[CXR]] for aspiration, ALI | |||
*Labs | |||
**Blood gas | |||
**CBC | |||
**Electrolytes | |||
**LFTs, hepatotoxicity | |||
**Serum glucose | |||
**BUN/Cr | |||
**CK, urinalysis | |||
**Toxicological screen | |||
**Serum toluene concentrations do not guide therapy<ref>Toluene. Baselt RC, ed. Disposition of Toxic Drugs and Chemicals in Man. 7th ed. Foster City, CA: Biomedical Publications; 2004. 1120-24.</ref> | |||
==Management== | ==Management== | ||
*If | *Call on-call toxicology | ||
*If found down with sudden death with history of recent inhalant abuse → give beta-blocker (propanolol, esmolol) | |||
**Thought to counteract myocardial sensitization | |||
**May be more effective than lidocaine<ref>Agency for Toxic Substances & Disease Registry. Medical Management Guidelines for Toluene. Oct 21, 2014. http://www.atsdr.cdc.gov/mmg/mmg.asp?id=157&tid=29.</ref> | |||
*Supportive care, cardioversion for dysrhythmias | |||
**Careful use of vasopressors as sympathomimetics may increase risk of dysrhythmias | |||
**Albuterol inhaled cautiously for bronchospasm | |||
**Aggressive potassium replacement, hydration, cardiac monitoring | |||
**Dialysis for recalcitrant renal failure | |||
==Disposition== | ==Disposition== | ||
*Based on patient's clinical status | |||
==See Also== | ==See Also== | ||
*[[Toxicology (Main)]] | |||
*[[Hydrocarbons]] | |||
==References== | ==References== | ||
*Camara-Lemarroy CR et al. Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study. BMC Emerg Med. 2015; 15: 19. | |||
<references/> | <references/> | ||
[[Category: | [[Category:Toxicology]] | ||
Latest revision as of 11:04, 25 September 2021
Background
- First described in the 1950s
- Most common abusant in preteens 11-13yo
- Most abused: gasoline, solvents like toluene, spray paints, lighter fluid, air fresheners, glue, and electronic cleaners (halogenated hydrocarbons)
- Includes: "sniffing", "huffing", "bagging", and "dusting"
Clinical Features
- General: Euphoria, hallucinations
- Neuro: Impaired motor activity, ataxia, depressed mentation, withdrawal potential
- Cardiac: Widened QRS, prolonged QT, syncope, arrhythmias
- Skin: May cause dermal burns
- "Sudden sniffing death" - thought to be occur with sudden catecholamine surge on a "sensitized" myocardium
- Other:
- Rhabdomyolysis, acute kidney injury
- Secondary renal tubular acidosis
- Hypokalemia
- Metabolic acidosis
- Hepatitis, hepatic failure
Differential Diagnosis
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
Toxic gas exposure
- Carbon monoxide toxicity
- Chemical weapons
- Cyanide toxicity
- Hydrocarbon toxicity
- Hydrogen sulfide toxicity
- Inhalant abuse
- Methane toxicity
- Smoke inhalation injury
- Ethylene dibromide toxicity
Evaluation
- Generally a clinical diagnosis
- ECG
- Consider CT head
- CXR for aspiration, ALI
- Labs
- Blood gas
- CBC
- Electrolytes
- LFTs, hepatotoxicity
- Serum glucose
- BUN/Cr
- CK, urinalysis
- Toxicological screen
- Serum toluene concentrations do not guide therapy[1]
Management
- Call on-call toxicology
- If found down with sudden death with history of recent inhalant abuse → give beta-blocker (propanolol, esmolol)
- Thought to counteract myocardial sensitization
- May be more effective than lidocaine[2]
- Supportive care, cardioversion for dysrhythmias
- Careful use of vasopressors as sympathomimetics may increase risk of dysrhythmias
- Albuterol inhaled cautiously for bronchospasm
- Aggressive potassium replacement, hydration, cardiac monitoring
- Dialysis for recalcitrant renal failure
Disposition
- Based on patient's clinical status
See Also
References
- Camara-Lemarroy CR et al. Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study. BMC Emerg Med. 2015; 15: 19.
- ↑ Toluene. Baselt RC, ed. Disposition of Toxic Drugs and Chemicals in Man. 7th ed. Foster City, CA: Biomedical Publications; 2004. 1120-24.
- ↑ Agency for Toxic Substances & Disease Registry. Medical Management Guidelines for Toluene. Oct 21, 2014. http://www.atsdr.cdc.gov/mmg/mmg.asp?id=157&tid=29.