Volatile Inhalant

Aka: Volatile Inhalant, Inhalation Drug Use, Inhalant Abuse, Volatile Inhalant Abuse, Sudden Sniffing Death Syndrome, Huffing

1. See Also
   1. Chemical Dependency
   2. Substance Abuse Evaluation
2. Forms
   1. Nitrous oxide ("laughing gas")
   2. Organic Nitrates
   3. Gasoline, Propane, or Hydrocarbons
      1. Butane (lighter fluid, hair spray, deodorants)
      2. Propane (Gas grill fuel, room freshener, spray paint)
      3. Fluorocarbons (Asthma or Analgesic spray, Freon gas)
      4. Chlorinated hydrocarbons (dry-cleaning, spot remover)
   4. Solvents (Thinners)
      1. Toluene (Paint thinner, glue, nail polish remover)
      2. Acetone (Nail polish remover, permanent markers)
      3. Trichloroethylene
      4. Perchlorethylene
   5. Other common agents with inhalants
      1. Paint Aerosols
      2. Whipped cream aerosol
      3. Cleaning fluid
      4. Correction fluid
3. Methods of abuse
   1. Sniffing: Inhaling substance from container
   2. Huffing: Rag soaked in agent placed over nose, mouth
   3. Bagging: Substance poured into a bag and inhaled
4. Signs and Symptoms
   1. See Substance Abuse Evaluation
   2. General observation
      1. Staining of clothes, Fingernails or skin
      2. Chemical inhalant odor to breath
   3. Mouth and nose changes
      1. Perioral lesions or discoloration
      2. Rhinorrhea
   4. Neuromuscular
      1. Nystagmus
      2. Diplopia
      3. Altered Level of Consciousness
      4. Mood instability
      5. Ataxia
      6. Impaired memory
5. Signs: Toxicity
   1. General
      1. Ataxia
      2. Respiratory depression
      3. Coma
      4. Permanent cerebral changes
         1. Imaging changes (atrophy, white matter loss)
         2. Cognitive deficits (Dementia, encephalopathy)
         3. Peripheral Neuropathy
      5. Marrow toxicity: Leukopenia, Thrombocytopenia, Anemia
      6. Hepatic toxicity
      7. Renal toxicity
         1. Renal Tubular Acidosis
         2. Fanconi's Syndrome
         3. Acute Renal Failure
      8. Cardiac toxicity with arrhythmia risk
      9. Suffocation when used with plastic bag
   2. Toluene (paint, lacquer, or glue)
      1. Hypokalemia
      2. Hypophosphatemia
      3. Renal Tubular Acidosis (RTA)
      4. Abdominal Pain
      5. Muscle Weakness
      6. Panacinar Emphysema
      7. Goodpasture's Syndrome
      8. Permanent cognitive deficits
      9. Ataxia
      10. Pregnancy complications
          1. Intrauterine Growth Retardation
          2. Perinatal death
   3. Inhaled Hydrocarbons
      1. Fatal cardiac arrhythmias
   4. Pregnancy related fetal affects
      1. Spontaneous Abortion
      2. Fetal Solvent Syndrome
         1. Similar to Fetal Alcohol Syndrome
6. Complications: Sudden Sniffing Death Syndrome
   1. Responsible for 50% of inhalant-related deaths
   2. Inhalant Abuser startled
      1. Results in sudden Catecholamine release
      2. Provokes lethal arrhythmia (Ventricular Fibrillation)
   3. Reference
      1. Bass (1970) JAMA 212:2075-9
7. Labs and diagnostic studies
   1. Aliphatic hydrocarbon testing by gas chromatography
      1. Obtain sample in EDTA or Heparin tube
   2. Urine toxicologic screening
      1. Screen for other concurrent ingestions
   3. Acute toxicity evaluation
      1. Complete Blood Count (CBC)
      2. Liver Function Tests
      3. Renal Function tests
      4. Electrolyte panel with calcium and phosphorus
      5. Creatinine Phosphokinase
      6. Electrocardiogram
      7. Arterial Blood Gas
8. Management: Toxicity
   1. Supportive care
   2. Avoid Epinephrine (and other arrhythmogenics)
   3. Administer Beta Blocker early in course
      1. Prevents Catecholamine induced arrhythmias
   4. Correct acid-base status
   5. No known antidote
9. Management: Chemical Dependency
   1. Chemical Dependency Treatment Programs
   2. Supportive care for withdrawal symptoms (uncommon)
      1. Withdrawal symptoms may persist for >1 month
      2. Symptoms may mimic Alcohol Withdrawal
10. References
    1. Anderson (2003) Am Fam Physician 68(5):869-74
    2. Brouette (2001) Am J Addict 10:79-94