Inhalant abuse: Difference between revisions
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==Background== | ==Background== | ||
[[File:USMC-07664.jpg|thumb|Example abused inhalants.]] | |||
*First described in the 1950s | *First described in the 1950s | ||
*Most common abusant in preteens 11-13yo | *Most common abusant in preteens 11-13yo | ||
| Line 20: | Line 21: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Drugs of abuse types}} | {{Drugs of abuse types}} | ||
{{Toxic gas exposure DDX}} | |||
== | ==Evaluation== | ||
*Generally a clinical diagnosis | *Generally a clinical diagnosis | ||
* | *[[ECG]] | ||
*Consider CT head | *Consider CT head | ||
*CXR for aspiration, ALI | *[[CXR]] for aspiration, ALI | ||
*Labs | *Labs | ||
**Blood gas | **Blood gas | ||
| Line 38: | Line 40: | ||
==Management== | ==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<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 | *Supportive care, cardioversion for dysrhythmias | ||
**Careful use of vasopressors as sympathomimetics may increase risk of 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== | ||
Latest revision as of 20:00, 24 April 2024
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.