Morning Report: Inhalant Abuse

Today’s Morning Report is presented by Dr. Youn!

Inhalant Abuse

Definitions: “the deliberate inhalation of vapors for the purpose of changing one’s consciousness or becoming ‘high’” (Goldfrank’s Toxicologic Emergencies)

– Sniffing: inhalation of a volatile substance directly from a container

– Huffing: pouring a liquid onto fabric, placing it over mouth/nose while inhaling

– Bagging: rebreathing from a bag in which solvent is instilled (spray paint)

– Dusting: inhalation of compressed air cleaners

Common Inhalants:

– glues/adhesives – toluene, benzene, tricholoethane

– spray paint – toluene, butane, propane

– paint thinner – toluene, methylene chloride, methanol

– hair spray – butane, propane, fluorocarbons

– “poppers” – amyl nitrite

– “whippits” – NO

Pharmacology:

– generally highly lipophilic, thus crossing blood brain barrier into CNS

– inhalants avoid first-pass hepatic metabolism; fast onset

– elimination via lungs; some produce toxic metabolites

– enhance GABA and glycine receptors; inhibit NMDA receptors

– cardiotoxicity – myocardial sensitization

Clinical Presentation:

– History: presence of products associated with inhalant abuse, witness accounts

– Physical Exam: Paint or stains on face, thermal or chemical burns of face/hands

– Neurologic: CNS depression, ataxia, headache, confusion,

– Cardiac: palpitations, tachycardia, ventricular dysrhythmias

– Pulmonary: pneumonitis, aspiration, cyanosis (methemoglobinemia)

– Chronic: irreversible CNS complications, RTA, rhabdo, liver disease, withdrawal

Management:

– ABCs, IV, O2, Cardiac monitor, pulse oximetry

– Supportive care

– EKG for dysrhythmia, CXR for aspiration

– Labwork? Electrolytes, COHb, co-ingestions

– GI contamination only if co-ingestion suspected

– Poison control

– Evaluation for potential trauma

– Sudden Sniffing Death Syndrome (SSDS): when the acutely intoxicated inhalant abuser is startled, causing the release of a burst of catecholamines that can trigger ventricular fibrillation

o Ventricular dysrhythmias: shocks and beta-blockers (propranolol/esmolol); avoid sympathomimetics