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Inhalant abuse
From WikEM
(Redirected from Inhalants)
Contents
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
- Cocaine
- Ecstasy
- Marijuana
- Amphetamines
- Alcohol
- Synthetic cannabinoids
- Bath salts
- Heroin
- 25C-NBOMe
- Inhalant abuse
- Gamma hydroxybutyrate (GHB)
- Phencyclidine (PCP)
- Psilocybin (magic mushrooms)
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.
- ↑ 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.
