0071643192.pdf

TOXICOLOGY

TREATMENT

■ Supportive therapy
■ Airway management and aspiration precautions

COMPLICATIONS

■ Rhabdomyolysis

Inhalants

Inhaled drugs of abuse are a diverse group of substances (see Table 6.19) that
are inhaled for their euphoric effects. Toxicity is unique to each substance.

HYDROCARBONS

Found in readily available household products, typically in the propellant;
inhaled via three common routes:

■ Sniffing: Directly inhaling from the source
■ Huffing: Inhaling from soaked cloth
■ Bagging: Inhaling from a bag that has been sprayed

Hydrocarbons are rapidly absorbed when volatilized and rapidly distribute to
the CNS because of their high lipid solubility.

MECHANISM/TOXICITY

■ Exact mechanism is not known.

SYMPTOMS/EXAM

■ Short-lived inebriation, euphoria, coma
■ Chronic abuse may result in an organic brain syndrome or peripheral
axonopathy.
■ “Sudden sniffing death”: Sensitization of the heart to catecholamines
results in VT or Vfib when startled.

TREATMENT

■ Supportive care

Hydrodrocarbon’s effect

rapidly resolves when exposed

to fresh air. Prolonged AMS

suggests other etiologies or

hypoxic damage.

TABLE 6.19. Toxicity of Common Inhaled Drugs of Abuse

INHALANT TOXICITY

Hydrocarbons (gasolines, oils) Sudden sniffing death

Peripheral axonopathy

Methylene chloride (paint stripper) Carbon monoxide poisoning

Toluene (glue) Non—anion gap metabolic acidosis (hippuric acid)

Nitrites Methemoglobinemia

Syncope

Nitrous oxide Sedation and coma

Vitamin B 12 deficiency