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  • Typical exposures:
    • Unintentional exposure (generally young children)
    • Intentional abuse (generally adolescents, young adults)
    • Occupational exposure - dermal, inhalation
  • Intentional abuse methods:
    • Huffing= hydrocarbon soaked into rag and placed over mouth and nose
    • Bagging= hydrocarbon placed in a bag and fumes inhaled
    • Sniffing= hydrocarbon inhaled directly
  • High volatility, low viscosity → high risk for aspiration despite "simple ingestion"


  • Gasoline
  • Lighter fluid
  • Lamp oil
  • Petroleum jelly (Vaseline)
  • Paint
  • Paint thinners
  • Polish

Clinical Features

  • Pulmonary: aspiration
    • Risk factors: high volume, vomiting, gagging, choking, coughing
    • CXR on presentation nonpredictive, but usually appear by 6hrs
  • Cardiac: arrhythmias, Afib, PVCs, Vtach, torsades
  • "Sudden sniffing death syndrome"= suspected cardiac sensitization to catecholamines
    • Classic scenario: Sniffer is startled during use, collapses and dies
  • CNS/PNS [1]
    • Stage 1: headache, dizziness, nausea, tinnitus
    • Stage 2: Slurred speech, confusion, hallucinations, diplopia, ataxia
    • Stage 3: Obtundation, seizure, death
  • Renal: Toluene in particular may cause weakness secondary to severe hypokalemia

Differential Diagnosis

Drugs of abuse



  • CXR: immediately if symptomatic, otherwise early CXR not predictive of pneumonitis. Observe for 4-6hrs then obtain CXR
  • Labs: as needed to evaluate for acidosis, anemia, renal/hepatic toxicity, coagulation, methemoglobinemia, carboxyhemoglobinemia depending on specific exposure
  • ECG


  • Clinical diagnosis, based on history and physical exam


  1. Pulmonary
    • Secure airway, if needed.
    • Beta2 agonist if wheezing (not proven benefit), consider Bipap/Cpap (may further barotrauma)
    • Severe toxicity will need intubation, high PEEP, possibly high frequency jet ventilation, and ECMO for refractory hypoxemia
    • Antibiotic prophylaxis show no benefit, but use if superinfection present
    • Steroids not recommended for chemical pneumonitis and can lead to increased superinfection
  2. Cardiovascular
    • Treat hypotension with aggressive IVF
    • Avoid dopamine, epinephrine, norepinephrine (may cause dysrhythmias)
    • Treat ventricular dysrhythmias with propranolol, esmolol, or lidocaine
  3. Dermal
    • Pre-arrival decontamination, remove clothing
    • Soap and water, saline for eye exposure
  4. GI


  • Discharge after 6 hour observation if:
    • Asymptomatic
    • Normal vital signs (including SpO2)
    • No abnormal pulmonary findings
    • Normal CXR at 6hrs post exposure
      • If asymptomatic but radiographic evidence of pneumonitis, consider discharge with 24-hour follow-up.
  • Admit:
    • Clinical evidence of toxicity

See Also


  1. Tormoehlen L et al. Hydrocarbon toxicity: A review. Clinical toxicology 2014; 52: 479-489