Inhalant abuse

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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

Differential Diagnosis

Drugs of abuse

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 founded 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.
  1. Toluene. Baselt RC, ed. Disposition of Toxic Drugs and Chemicals in Man. 7th ed. Foster City, CA: Biomedical Publications; 2004. 1120-24.
  2. 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.

Authors:

Ross Donaldson