Ver el código de «Inhalant abuse»

==Background==
[[File:USMC-07664.jpg|thumb|Example abused inhalants.]]
*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 types}}
{{Toxic gas exposure DDX}}
{{Inhalation exposure}}

==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<ref>Toluene. Baselt RC, ed. Disposition of Toxic Drugs and Chemicals in Man. 7th ed. Foster City, CA: Biomedical Publications; 2004. 1120-24.</ref>

==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
**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==
*[[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.
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[[Category:Toxicology]]