eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Hydrocarbon Inhalation Injury: Differential Diagnoses & Workup

Author: Jason M Kane, MD, FAAP, Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine; Attending Physician, Department of Pediatrics, Section of Pediatric Critical Care and Cardiac Intensive Care, Children's Memorial Hospital
Coauthor(s): Emily B Nazarian, MD, Fellow, Department of Pediatrics, Division of Critical Care, University of Rochester Medical Center; Heidi Connolly, MD, Associate Professor of Pediatrics and Psychiatry, University of Rochester; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center
Contributor Information and Disclosures

Updated: Jun 25, 2008

Differential Diagnoses

Acidosis, Metabolic
Toxicity, Tricyclic Antidepressant
Inhalation Injury
Ventricular Fibrillation
Status Epilepticus
Toxicity, Carbon Monoxide
Toxicity, Ethanol

Other Problems to Be Considered

Other causes for altered mental status:

  • Intracranial pathology
  • Electrolyte abnormality
  • Hepatic encephalopathy
  • Encephalitis

Comorbidities:

  • Multidrug ingestion
  • Other illicit drugs of abuse
  • Sexually transmitted diseases

Workup

Laboratory Studies

When solvent-inhalant abuse is suspected, specific solvent identification should be requested from the laboratory because solvent inhalants are infrequently included in routine toxicologic screening tests.30

  • Complete toxicology screening should be performed because patients who abuse one drug may be simultaneously abusing others.
  • Perform serologic investigation of renal and hepatic dysfunction, as well as blood and urine testing for rhabdomyolysis.
  • Obtain serum electrolyte levels to diagnose hypokalemia, hypophosphatemia, hypercalcemia, and acidosis from distal renal tubular acidosis caused by chronic hydrocarbon abuse.
  • If indicated from the history and physical examination, laboratory tests should be performed for sexually transmitted disease and, possibly, pregnancy (due to disinhibition and poor judgment). Pregnancy testing should be performed in all solvent-abusing females of reproductive age because of the risk of toluene embryopathy.

Other Tests

  • ECG and echocardiography
    • Identify pulmonary hypertension
    • Evaluate for cardiomyopathy
    • Identify and document dysrhythmias
  • Pulmonary function testing to look for evidence of restrictive disease
  • Neurophysiologic and neuropsychiatric tests for patients with evidence of chronic inhalant use
  • Neuromotor testing in patients with symptoms of peripheral neuropathy

More on Hydrocarbon Inhalation Injury

Overview: Hydrocarbon Inhalation Injury
Differential Diagnoses & Workup: Hydrocarbon Inhalation Injury
Treatment & Medication: Hydrocarbon Inhalation Injury
Follow-up: Hydrocarbon Inhalation Injury
References
Further Reading
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References

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  3. Jones HE, Balster RL. Inhalant abuse in pregnancy. Obstet Gynecol Clin North Am. Mar 1998;25(1):153-67. [Medline].

  4. Bass M. Sudden sniffing death. JAMA. Jun 22 1970;212(12):2075-9. [Medline].

  5. LoVecchio F, Fulton SE. Ventricular fibrillation following inhalation of Glade Air Freshener. Eur J Emerg Med. Jun 2001;8(2):153-4. [Medline].

  6. Edwards KE, Wenstone R. Successful resuscitation from recurrent ventricular fibrillation secondary to butane inhalation. Br J Anaesth. Jun 2000;84(6):803-5. [Medline].

  7. El-Menyar AA, El-Tawil M, Al Suwaidi J. A teenager with angiographically normal epicardial coronary arteries and acute myocardial infarction after butane inhalation. Eur J Emerg Med. Jun 2005;12(3):137-41. [Medline].

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  11. Frangides CY, Tzortzatos GV, Koulouras V, et al. Acute massive rhabdomyolysis due to prolonged inhalation of liquid gas. Eur J Emerg Med. Mar 2003;10(1):44-6. [Medline].

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  28. Westermeyer J. The psychiatrist and solvent-inhalant abuse: recognition, assessment, and treatment. Am J Psychiatry. Jul 1987;144(7):903-7. [Medline].

  29. Padilla ER, Padilla AM, Morales A, et al. Inhalant, marijuana, and alcohol abuse among barrio children and adolescents. Int J Addict. Oct 1979;14(7):945-64. [Medline].

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Further Reading

National Institute on Drug Abuse. NIDA Research Report - Inhalant Abuse. National Institutes of Health. Available at http://www.nida.nih.gov/researchreports/inhalants/Inhalants.html. 

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Keywords

hydrocarbon inhalation injury, volatile substance abuse, inhalant abuse, solvent abuse, sniffing, huffing, bagging, solvent, butane, toluene, sudden cardiac events, sudden sniffing death syndrome, ventricular dysrhythmias, sudden death, myocardial infarction, renal tubular acidosis, hypokalemia, hyperchloremia, frostbite, bone marrow damage, aplastic anemia, leukemia, toxic hepatitis, pulmonary injury, microcephaly, narrow bifrontal diameter, short palpebral fissures, hypoplastic mid face, wide nasal bridge, abnormal palmar creases, blunt fingertips, pulmonary hypertension, hydrocarbon aspiration, Parkinson disease, attention deficit, rhabdomyolysis, rhinitis, nasal mucosal erosions, epistaxis, hoarse voice, conjunctivitis, hypophosphatemia, hypercalcemia

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Contributor Information and Disclosures

Author

Jason M Kane, MD, FAAP, Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine; Attending Physician, Department of Pediatrics, Section of Pediatric Critical Care and Cardiac Intensive Care, Children's Memorial Hospital
Jason M Kane, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Emily B Nazarian, MD, Fellow, Department of Pediatrics, Division of Critical Care, University of Rochester Medical Center
Emily B Nazarian, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Heidi Connolly, MD, Associate Professor of Pediatrics and Psychiatry, University of Rochester; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center
Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis Center
Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Associate Professor, Department of Clinical Pediatrics, State University of New York at Stony Brook
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics, American Heart Association, and American Thoracic Society
Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD, Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center; Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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