AUTHOR AND EDITOR INFORMATION

Section 1 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

INTRODUCTION

Section 2 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Background

Inhalants are volatile substances producing vapors that can be taken intentionally via the pulmonary route to produce a mind-altering "buzz" or high. Inhalants are dangerous and their use represents a vast abuse problem in the United States and abroad. At greatest risk of harm from these drugs are adolescents in their early teenage years. Although most inhalants are central nervous system (CNS) depressants, they do cause adverse medical effects on almost every organ system in the body. Both short- and long-term toxic effects occur. Short-term effects include diplopia, impaired memory, slurred speech, seizure, or even death from cardiac arrhythmias. Long-term chronic effects include permanent ataxias or sensorimotor peripheral neuropathies, blindness, cognitive impairment, and renal toxicity.

Historically, the use of inhaled volatile chemicals in religious ceremonies dates back to antiquity. Recreational use of inhalants in the United States increased in the 1950s and is now widespread amongst adolescents. Inhalants are frequently the first consciousness-altering substance abused by children. More than 1000 abusable products containing volatile chemicals are legal and readily obtained. These include solvents, aerosols, adhesives, fuels, dry-cleaning agents, tape-head cleaners, cigarette lighters, permanent markers, correction fluid, propellants used in whipped cream, deodorants, paints, and cooking sprays. These products are readily available, easy to purchase, not illegal to possess, easy to conceal, and can be found in every household or garage. They offer a quick-onset high of brief duration, lessening the chances of getting caught. Prosecution of offenders tends to be minimal, and few states have laws prohibiting inhalant abuse.

Although several categories of inhalants exist, the most commonly abused inhalants are the aliphatic hydrocarbons, alkyl halides, nitrites, and aromatic hydrocarbons.

• Aliphatic hydrocarbons are volatile fuels such as propane, butane (cigarette lighter fluid), and gasoline.


• Alkyl halides, 1,1,1-trichloroethane or trichloroethylene, are found in cleaning fluids, typewriter correction fluid, and compressed air for cleaning electronics.


• Nitrites, such as amyl nitrites found in room air fresheners, are used by some adolescents and homosexual men to enhance sexual activity.


• Aromatic hydrocarbons, such as toluene and xylene, are the most commonly used inhalants of abuse. This is because they cause an intense euphoric rush when inhaled. They are found in markers, adhesive cements, model glues, paint thinners, and spray paints, with the highest concentration found in gold and silver spray paint.

Terminology

"Sniffing" - Inhaling vapors from an open container

"Huffing" - Soaking a rag or sock with substance and placing it over the mouth and nose

"Bagging" - Spraying or pouring the substance into a paper or plastic bag and inhaling the vapors by placing the bag over the face or over the head

"Dusting" - Inhaling vapors directly from electronic equipment cleaning aerosols

Pathophysiology

Inhalants are highly lipid soluble; they easily cross both alveolar membranes in the lungs and then the blood-brain barrier to reach high concentrations in the brain. Inhalation avoids first-pass hepatic metabolism so the onset is fast. The onset of effect is seen in a few seconds to a few minutes, with peak plasma concentration 15-30 minutes after inhalation. The inhaled concentration depends on the mode of administration. Sniffing offers the lowest concentration, followed by huffing, with bagging offering the highest concentration. With a few exceptions, elimination occurs primarily through the lungs, with many inhaled compounds eliminated unchanged by exhalation. Some of the inhalants, including alkyl nitrites, aromatics, and methylene chloride, undergo significant hepatic metabolism that can produce damaging free nitrites and toxic carbon monoxide as byproducts.

The mechanism of inhalant's effects is not fully understood. Some authors propose the action is similar to the action of ethanol. They suggest the action is to stimulate the gamma-aminobutyric acid (GABA) and the glycine a1 receptors, as well as inhibit the N-methyl-D-aspartate (NMDA) receptor, leading to inhibition in the CNS. Other proposed mechanisms include fluidization or solubility changes of neuronal cell membranes. Pharmacologic properties of all inhalants vary, contributing to different gas potentials, solubility in the blood, and elimination, leading to slight differences in their actions, intoxicating effects, and abuse potential. More research is needed to better define these mechanisms of action.

Frequency

United States

Inhalant abuse is common among adolescents; more than 2 million children aged 12-17 years are reported to have used inhalants at least once in their lifetime and use continues to climb in the younger age groups. The most recent report by Monitoring the Future Study (MTF), a survey funded by the National Institute of Drug Abuse (NIDA), that monitors drug abuse in adolescents from grades 8-12, reported an increase in the annual base of inhalants from 2002-2005 in 8th graders (from 7.7-9.5%), while the annual abuse for 10th and 12th graders remained stable at 6% and 5% respectively.

In the United States, inhalant abuse usually precedes tobacco and alcohol experimentation. Although most teenagers outgrow inhalant use, many progress to "harder" drugs, including marijuana and cocaine.

Inhalant abuse is less common (though not rare) in adults. Those especially at risk are doctors, nurses, factory workers, dentists, shoemakers, hair stylists, painters, and dry-cleaning workers; all with ready access to chemicals or anesthetics. Besides the chemical high offered by these drugs, some adults seek an additional aphrodisiac effect reported to occur with some of these chemicals. Nitrite inhalant use, for example, is prevalent amongst homosexual males. In one survey, 69% of homosexual males sampled had experience with nitrite inhalants, though the AIDS crisis has likely decreased these numbers.

International

Across the globe, inhalant abuse is rampant among children in both developed areas and developing areas. Countries with particularly high abuse rates include Great Britain, Singapore, and Brazil.

Mortality/Morbidity

The debilitating and potentially lethal effects of inhalants can occur even with the first use. Although inhalant deaths are underreported in the United States, the 2005 report of the National Inhalant Prevention Coalition (NIPC) reports 100-125 deaths annually as a result of inhalant abuse.¹ Asphyxiation can result from the displacement of oxygen in the lungs by prolonged or repeated inhalations. Suffocation can occur if a plastic bag is placed over the head when inhaling the fumes and the user becomes unconscious. Death can also occur because of complications of the intoxication such as choking on aspirated gastric contents, fire-related injuries from inhalant combustion, or fatal injuries suffered as a result of high-risk behaviors.

A common cause of death in inhalant abusers is called sudden sniffing death syndrome (SSDS). Although the exact mechanism is unknown, the inhalant is believed to sensitize the myocardium to circulating catecholamines. This causes an exaggerated response to epinephrine released during a sudden alarm or increased physical activity, leading to a fatal arrhythmia. Death usually occurs while the user is running, attempting to flee, experiencing a particularly frightful hallucination, or during sexual activity. An in vitro study by Cruz et al, demonstrated that toluene inhibition of voltage-gated cardiac sodium channels may be the possible mechanism of increased sensitivity.²² The co-ingestion of a sympathomimetic agent, such as cocaine, may increase the risk of the fatal arrhythmia. Sudden sniffing death is particularly associated with the abuse of toluene, butyl nitrate, butane, propane, and chemicals in aerosols.

Inhalant abuse is associated with significant morbidity and mortality. Bowen and colleagues studied inhalant-related deaths in Virginia from 1987-1996 and documented the dangers of these drugs. In the 10-year study period, 39 deaths resulting from acute voluntary exposure were reported, an average of 4 deaths per year. These drugs have no social or geographic boundaries, but children abusing inhalants tend to be of lower socioeconomic class, male gender, suffering delinquency, and from broken families.

Race

Inhalant abuse rates are higher in white, Hispanic, and Native American children.

Sex

Abuse tends to be more prevalent in males, but over the past 2 decades, abuse has increased in females.

Age

The typical abusers of inhalants are aged 10-15 years, although use in children as young as 7 and 8 years has been reported. The average age of initial use of these chemicals was around 10 years in one study, which preceded the average initiation into cigarettes by 1.5 years and narcotics by almost 4 years. Experimentation typically occurs in late childhood and is short lived. Chronic abuse is usually seen in older adolescents, although it has also been reported as late as the fifth and sixth decades of life.

CLINICAL

Section 3 of 11  

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• Clinical
• Differentials
• Workup
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• Follow-up
• Miscellaneous
• Multimedia
• References

History

Many children abuse inhalants regularly; however, only those who develop complications are likely to present to the emergency department or primary care physician. The clinician, especially the primary care physician, must therefore maintain a high index of suspicion for inhalant abuse in any patient presenting with unexplained and often vague complaints.

In the emergency department setting, the acutely intoxicated patient most frequently arrives by ambulance, with the police, or with friends and family. In obtaining the history, ask prehospital personnel about empty chemical or spray containers found at the scene. Ask about rags, cloths, or strange smells about the patient. Also inquire about the possibility of co-ingestion, suggested by pill bottles found at the scene.

As inhalant abuse is typically a group activity, elicit a history from friends or family who were present. Discuss with parents changes in behavior or school performance, new groups of friends, or new types of social activities that might suggest use of these drugs. Strongly suspect inhalant abuse in the setting of sudden collapse during adolescent group activities. Occult trauma is common in these patients, as lost inhibition leads to dangerous activities during intoxication.

The clinical history can be broken down into acute intoxication, chronic inhalation use, and withdrawal syndrome.

• Acute intoxication - most symptoms resolve within 2 hours
• • In acute intoxication, neurologic, cardiac, and pulmonary symptoms predominate.
  
  
  • Acute neurologic symptoms resemble alcohol intoxication and include euphoria, slurred speech, ataxia, dizziness, diplopia, confusion, and CNS depression. Potential acute effects include headache, vertigo, auditory and visual hallucinations, seizures, stupor, and coma
  
  
  • Acute cardiac effects include heart palpitations and tachycardia.
  
  
  • Pulmonary symptoms are due to asphyxiation and direct lung damage, producing pneumonitis. In the history, inquire about dyspnea, wheezing, and coughing. Cyanosis of the extremities can develop secondary to methemoglobinemia associated with alkyl nitrite abuse and can produce skin discoloration and cyanosis.


• Chronic abuse
• • In chronic inhalant abuse, irreversible CNS complications can occur, including cerebral cortex atrophy, cerebellar degeneration, peripheral neuropathy, and neuropsychosis, leading to cognitive function decline, dementia, gait disturbances, and loss of coordination. Neurologic signs and symptoms to elicit include peripheral neuropathies (typically stocking-glove distribution), seizures, paresthesias, ataxia, weakness, confusion, memory loss, and delusions.
  
  
  • Long-term exposure can also lead to cranial nerve damage, causing optic neuropathy and blindness, tinnitus, and sensorineural hearing loss.
  
  
  • Chronic renal injury from inhalant use includes type I renal tubular acidosis, urinary calculi, and glomerulonephritis and typically produces flank pain, clouding of the urine, and decreased urine production with azotemia.
  
  
  • Toxic hepatitis and liver failure has also been seen in chronic users of chlorinated hydrocarbons by damage of toxic metabolites. The history may reveal symptoms of right upper quadrant abdominal pain, nausea, vomiting, low-grade fever, fatigue, or jaundice.
  
  
  • Rhabdomyolysis and severe muscle weakness, similar to Guillain-Barré syndrome, has also been reported.


• Withdrawal symptoms
  
  
  • These symptoms include tremors, irritability, anxiety, insomnia, delirium, tingling sensations, seizures, and muscle cramps. If tolerance has developed, complaints of chills, headache, muscle cramps, and vague abdominal pain should be elicited.
  
  
  
  • These patients present with sleep disturbance, tremor, nausea, irritability, and abdominal pain. Withdrawal symptoms are worse during the period 2-5 days after inhalant cessation. Patients may present with symptoms similar to delirium tremens.
  
  

If the inhalant abuse patient is pregnant, special considerations need to be taken. Although well-controlled prospective data have not been collected, current information suggests adverse effects of maternal inhalant abuse on the fetus. Because of high lipophilicity, these solvents readily cross the placenta and cause fetal anomalies, including microcephaly, narrow bifrontal diameter, hypoplastic midface, and blunt fingertips. This syndrome closely resembles the physical findings of fetal alcohol syndrome. Increased rates of spontaneous abortion and fetal malformations have been reported, as have growth retardation and deficits in both speech and cognitive skills.

Physical

• Skin
• • Paint or stains on the face, hands, or clothing (see Media files 1-2)
  
  
  • "Huffer rash" - Erythematous "frost bite" eruption on the face and oral mucosa caused by severe drying and cracking of the skin and resultant bacterial infection
  
  
  • Thermal or chemical burns on the face or hands
  
  
  • Conjunctival injection
  
  
  • Jaundice (with chronic hepatic injury)
  
  
  • Cyanosis (with methemoglobinemia)


• Respiratory
• • Chemical odor in the breath
  
  
  • Wheezing, rhonchi, or rales
  
  
  • Oral or airway burns
  
  
  • Rhinitis
  
  
  • Respiratory distress with aspiration of gastric contents


• Neurologic/psychiatric
• • Slurred speech
  
  
  • Diplopia
  
  
  • Blurred vision
  
  
  • Nystagmus
  
  
  • Euphoria
  
  
  • Psychomotor retardation
  
  
  • Disorientation
  
  
  • Sense of invulnerability
  
  
  • Distortion of space and time
  
  
  • Auditory or visual hallucinations with paranoid ideations
  
  
  • Photophobia
  
  
  • Weakness
  
  
  • Impaired memory
  
  
  • Peripheral neuropathy (typically stocking-glove distribution)
  
  
  • Seizures
  
  
  • Agitated coma (unconsciousness with tremors, restlessness, and hyperreflexia)


• Cardiac
• • Arrhythmias, including premature ventricular contractions (PVCs) or supraventricular tachycardia (SVT)
  
  
  • Tachycardia or bradycardia
  
  
  • Hypotension


• Gastrointestinal tract
  
  
  • Nausea and vomiting
  
  
  • Diarrhea
  
  
  • Abdominal pain (suspect hepatic injury if the pain is in the right upper quadrant, especially in a chronic abuser)
  
  
  • Flank pain (suspect renal injury in chronic abusers)

Causes

The cause of inhalational injury is the use of inhalation agents. As described earlier, this use is affected by many factors such as age and socioeconomic status (see Frequency and Mortality/Morbidity).

DIFFERENTIALS

Section 4 of 11  

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Other Problems to be Considered

Alcohol (ethanol)-related syndromes
Arrhythmia
Asphyxiation
Ataxia
Carbon monoxide poisoning
Cyanide poisoning
Delirium
Diabetic ketoacidosis
Drug effects (anticholinergic, antiepileptic, antidepressants, antipsychotics, antiparkinsonians, anxiolytics, opiates)
Ethanol
Infectious diseases
Marijuana
Metabolic abnormalities
Phencyclidine
Psychosis and other psychiatric diseases
Substance abuse
Sudden death
Trauma, evident or occult

WORKUP

Section 5 of 11  

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• Follow-up
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• Multimedia
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Lab Studies

• As with every patient, the laboratory workup depends upon the severity of the illness. For anything more severe than mild intoxication, the following tests are generally recommended:
• • Pulse oximetry: Pulse oximetry assesses the degree of oxygenation and general state of pulmonary effort and function.
  
  
  • Serum chemistry: Analyses should include a standard renal panel including sodium, potassium, chloride, bicarbonate, BUN, and creatinine. Some of the inhalants, toluene in particular, cause a syndrome of distal renal tubular acidosis, with a resultant elevated anion gap, hyperchloremia, hypokalemia, and hypophosphatemia. Azotemia is also common with chronic exposure but resolves with abstinence. Hypoglycemia may be noted.
  
  
  • Arterial blood gases (ABGs): This study can be helpful in cases of inhalant intoxication. Significant acidosis, hypoxemia, or hypercarbia may suggest the need for patient intubation.
  
  
  • Complete blood count (CBC): CBC is useful as a routine screening laboratory test. Chronic users may exhibit bone marrow suppression, thrombocytopenia, and aplastic anemia.
  
  
  • Urinalysis: Elevated urobilinogen suggests hepatic involvement. Hyaline casts, elevated white blood cell counts, elevated red blood cell counts, or abnormal glucose and protein levels may suggest renal injury.
  
  
  • Creatine phosphokinase (CPK): Useful in patients with muscle tenderness or myoglobinuria to evaluate the presence of rhabdomyolysis.
  
  
  • Serum or urine toxicology: Toxicology screens may be helpful if the specific chemical involved is unknown. Specific toxicologic tests of inhalant agents are not readily available in all laboratories and may take several days to weeks to get results so they are not helpful in the immediate diagnosis. Consult with the laboratory regarding their ability to test for specific agents.
  
  
  • Pregnancy testing should be done in all solvent-abusing females because of the risk of embryopathy caused by these agents.

Imaging Studies

• Imaging studies can be useful adjuncts to the history, physical, and laboratory evaluation. Suggested studies include chest x-ray films and head CT scan.
• • Chest radiograph: This study helps identify the etiology of respiratory difficulties associated with inhalant abuse. These include pneumothorax, aspiration pneumonia, or chemical pneumonitis with patchy or diffuse infiltrates. Chronic abusers with subsequent cardiomegaly might exhibit enlarged heart size and pulmonary edema.
  
  
  • Head CT scan: If occult trauma is suspected in the inhalant abuse patient, be liberal with CT scanning to rule out intracranial hemorrhage and occult fractures. Chronic abusers may show signs of cerebral or cerebellar atrophy.

Other Tests

• ECG/cardiac monitoring: Many inhalants are proarrhythmic; therefore, acutely intoxicated patients should have continuous ECG monitoring. ECG often show tachycardia, bradycardia, arrhythmias, or even cardiac ischemia with solvent abuse.

Procedures

• Follow advanced cardiac life support (ACLS) guidelines.


• Consider oral or tracheal intubation in any patient with significantly decreased level of consciousness, inability to protect the airway, or severe oropharyngeal thermal injury secondary to inhalation.


• Obtain peripheral or central intravenous (IV) access in all patients with suspected significant intoxication.


• Cardioversion may be necessary if ventricular arrhythmias are present.

TREATMENT

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Medical Care

Appropriate medical care for the inhalant-abusing patient is dictated by the severity of injury and the setting of care. The following medical care is recommended for patients with acute intoxication.

• Prehospital care: Start by securing the patient's airway, breathing, and circulation. Follow standard ACLS protocols, keeping in mind that inhalant-abuse patients may experience hallucinations and become combative. Restraints should be applied carefully, if at all, and in accordance with local policy. Sufficient personnel should assist with moving the patient to the hospital to ensure the safety of both the patient and the EMS crew. If saturated with solvent, the patient's clothing should be removed to prevent worsening intoxication and to protect EMS personnel. Supply supplemental oxygen and obtain IV access if appropriate.


• Emergency department care begins by protecting the patient's airway as dictated by level of consciousness and the ability of the patient to control their airway. Intubation may be required, so have appropriate equipment and personnel available. Place the patient on supplemental oxygen. Cautiously treat bronchospasm (if present) with aerosolized beta-agonists, bearing in mind that these agents may induce arrhythmias in the inhalant-sensitized heart. If severe bronchospasm is present, systemic steroids (in doses similar to those used with acute asthma exacerbations) can be helpful.
• • Obtain intravenous access and begin cardiac monitoring. Treat hypotension with supine patient positioning and intravenous fluid boluses. Use catecholamine pressors if necessary, but remember that these agents also cause cardiac sensitization and are proarrhythmic. Severe patient agitation should be treated with benzodiazepines or with haloperidol. Remember that sudden death in these patients often involves sudden or strenuous activity; therefore, minimize patient agitation as much as possible.
  
  
  • Measure electrolytes, including potassium, calcium, and phosphorus and replete as necessary because abnormal values can exacerbate cardiac dysrhythmias and muscle weakness.
  
  
  • GI decontamination is generally not recommended unless co-ingestion is suspected, in which case, activated charcoal or an electrolyte solution (eg, GoLYTELY) may be indicated.
  
  
  • Specific laboratory tests and antidotes may be indicated for the following volatiles:
    
    
    • Methylene chloride: Check carboxyhemoglobin level, use 100% nonrebreather oxygen, and consider hyperbaric oxygen treatment for the critically ill. These patients require prolonged monitoring and treatment (at least 12-24 h), because the carbon monoxide level resolves more slowly than in inhaled carbon monoxide poisoning.
    
    
    • Alkyl nitrites: Check serum methemoglobin levels. For levels more than 30% in symptomatic patients, administer methylene blue, 1-2 mg/kg IV over 5 minutes; repeat in 30-60 minutes as necessary. Total dose should not exceed 7 mg/kg to prevent a promethemoglobin paradoxical effect.
    
    
    • Carbon tetrachloride: Consider hepatic injury and necrosis. Experimental evidence supports use of N-acetyl-cysteine (NAC), charcoal hemoperfusion, and hyperbaric oxygen.
    
    
    • Gasoline: Chronic gasoline sniffing formerly was associated with lead poisoning; thus, lead testing might be warranted. Gasoline sold in the United States today is generally unleaded. Check blood lead level if appropriate and treat elevated levels accordingly with chelating agents.

Consultations

• Consulting a toxicologist or a local poison control center for any acute inhalant intoxication is appropriate and encouraged.
• A cardiologist should be consulted if ventricular arrhythmias are present and persistent.

MEDICATION

Section 7 of 11  

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The goals of pharmacotherapy are to neutralize the effects of the toxic chemical, to reduce morbidity, and to prevent complications.

Drug Category: Vasopressors

These drugs augment both coronary and cerebral blood flow present during low flow states.

Drug Name	Epinephrine (Adrenalin, Bronitin, EpiPen)
Description	Indicated in bolus form for asystole or pulseless arrest; indicated as continuous IV infusion for shock or significant hypotension after ensuring adequate intravascular volume.
Adult Dose	Follow ACLS protocols
Pediatric Dose	Follow PALS protocols
Contraindications	Documented hypersensitivity; inadequate intravascular volume; cardiac arrhythmia
Interactions	Increases toxicity of beta- and alpha-blocking agents and that of halogenated inhalational anesthetics; do not mix with sodium bicarbonate
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Caution in elderly, prostatic hypertrophy, hypertension, cardiovascular disease, diabetes mellitus, hyperthyroidism, and cerebrovascular insufficiency; rapid IV infusions may cause death from cerebrovascular hemorrhage or cardiac arrhythmias; as it may cause significant tachycardia, be aware that rising blood pressure and increasing heart rate may cause myocardial ischemia and increase in myocardial oxygen demand

FOLLOW-UP

Section 8 of 11  

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Further Inpatient Care

• Remember only those with significant inhalant-related complications are likely to reach the emergency department; these patients benefit from hospitalization for medical observation. In addition, psychiatric and social intervention is often necessary to prevent further abuse.
• Although the acute intoxication may only last 15-45 minutes, drowsiness, disorientation, and stupor may persist for hours or even days, and chronic effects may last a lifetime.
• ICU admission is certainly advised for any patient with hemodynamic instability, respiratory impairment, cardiac arrhythmias, or continued decreased level of consciousness. Close observation is necessary for worsening oxygenation and deterioration.

Further Outpatient Care

• Appropriate drug intervention programs and psychological counseling should be arranged prior to discharging the patient.

Transfer

• If a patient requires prolonged cardiac monitoring or medical intensive care but such facilities are not available at the hospital in which the patient is admitted, transfer the patient to an appropriate tertiary hospital.

Deterrence/Prevention

• Risks and dangers of inhalant abuse should be explained to the patient. Dysfunctional family settings increase chances of return to inhalant use, and additional supervision may be required for these patients after discharge.

Complications

• Complications of inhalant abuse include the following:
  
  
  • Cardiac - Sudden death, myocardial infarction, cardiac arrhythmias
  
  
  • Neurologic - Memory and cognitive impairment, blindness, psychosis, seizures, tetany
  
  
  • Pulmonary - Respiratory arrest, aspiration
  
  
  • Renal - Electrolyte disturbance, renal failure, hypocalcemia (particularly during fluid repletion)
  
  
  • Hepatic - Hepatic failure, hepatitis
  
  
  • Legal - Risk behaviors may lead to illegal activities or future forms of substance abuse.

Prognosis

• In general, the prognosis for inhalant abuse is good if the pattern of abuse is recognized early. Significant morbidity is the rule in prolonged chronic abuse. The pulmonary, renal, cardiac, and gastrointestinal sequelae usually resolve with abstinence.

Patient Education

• Patients and their parents need to be educated about inhalants and their devastating consequences. Education can occur through physician-patient discussion, referral to online resources, and third-party counseling on inhalant abuse. Adolescents have the legal right to receive confidential services for substance abuse, mental health, and reproductive health. Medical care providers can decide when parental involvement is appropriate and necessary.


• To obtain further information, the following organizations may be contacted:
• • National Clearinghouse for Alcohol and Drug Information
    PO Box 2345
    Rockville, MD 20847-2345
  
  
  • National Institute on Drug Abuse
    5600 Fishers Lane
    Rockville, MD 20857
    Phone: (301) 442-1124
  
  
  • National Inhalant Prevention Coalition
    1201 W. Sixth Street, Suite C-200
    Austin, TX 78703
    Phone: (800) 269-4237 or (512) 480-8953
    Fax: (512) 477-3932
    e-mail: nipc@io.com


• According to the National Inhalant Prevention Coalition (NIPC), treatment facilities for inhalant users are rare and difficult to find. A network of nationwide contacts exists through the NIPC, both for medical information and in locating treatment centers in the neighboring area.


• For excellent patient education resources, visit eMedicine's Substance Abuse Center. Also, see eMedicine's patient education articles Drug Dependence and Abuse and Substance Abuse.

MISCELLANEOUS

Section 9 of 11  

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• Follow-up
• Miscellaneous
• Multimedia
• References

Medical/Legal Pitfalls

• Failure to identify inhalant abuse as a diagnosis
• Failure to admit the patient for adequate observation and monitoring
• Failure to recognize progressive pulmonary dysfunction following acute ingestion, because patients may experience rapid pulmonary decline, particularly with aspiration of the hydrocarbons

Special Concerns

• Pregnancy, as described in History

MULTIMEDIA

Section 10 of 11  

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• Differentials
• Workup
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• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Media file 1:  This young man was huffing green spray paint. Note the presence of the paint on his hands and face.
	View Full Size Image
Media type:  Photo

Media file 2:  This picture shows a close-up of the face of a young man who had been huffing green spray paint.
	View Full Size Image
Media type:  Photo

REFERENCES

Section 11 of 11

• Authors and Editors
• Introduction
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• Follow-up
• Miscellaneous
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• References

1. National Inhalant Prevention Coalition. National Inhalant Prevention Coalition Web site. [Full Text].
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5. Bowen SE, Hannigan JH. Developmental toxicity of prenatal exposure to toluene. AAPS J. 2006;8(2):E419-24. [Medline].
6. Chepesiuk R. Resurgence of teen inhalant use. Environ Health Perspect. Dec 2005;113(12):A808. [Medline].
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13. McGuinness TM. Nothing to sniff at: inhalant abuse & youth. J Psychosoc Nurs Ment Health Serv. Aug 2006;44(8):15-8. [Medline].
14. McHugh MJ. The abuse of volatile substances. Pediatr Clin North Am. Apr 1987;34(2):333-40. [Medline].
15. Miller NS, Gold MS. Organic solvent and aerosol abuse. Am Fam Physician. Jul 1991;44(1):183-9. [Medline].
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17. Muller, AA, Muller, GF. Inhalant abuse. J Emerg Nurs. 2006;32:447-8. [Medline].
18. National Institute on Drug Abuse. Student Drug Use Attitudes and Beliefs: National Trends, 1975-1982. US Government Printing Office; 1982.
19. US Dept of Health and Human Services. 2001 Monitoring the Future Survey. HHS News; [Full Text].
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Article Last Updated: Jul 9, 2007