Inhalant abuse

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

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

Diagnosis

• Generally a clinical diagnosis
• EKG
• 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

Management

• Supportive care, cardioversion for dysrhythmias
  • Careful use of vasopressors as sympathomimetics may increase risk of dysrhythmias
• If founded down with sudden death with history of recent inhalant abuse → give beta-blocker (propanolol, esmolol)
  • Thought to counteract myocardial sensitization

Disposition

• Based on patient's clinical status

See Also

• Toxicology (Main)
• Hydrocarbons

References

• Camara-Lemarroy CR et al. Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study. BMC Emerg Med. 2015; 15: 19.