Hydrocarbon Inhalation Injury Follow-up

  • Author: Jason M Kane, MD, FAAP; Chief Editor: Michael R Bye, MD   more...
 
Updated: May 24, 2010
 

Further Inpatient Care

Ongoing psychiatric and social intervention is necessary to prevent recidivism. Access to solvent-inhalants should be eliminated as much as possible. Disorganized family settings with inadequate supervision increase the likelihood of return to abuse, and supervised foster care placement may be necessary.

Discontinuation of long-standing solvent-inhalant abuse may result in withdrawal symptoms, including tremor, agitation, tachycardia, hallucinations, and seizures, within hours to days of stopping use. Long-acting sedatives, such as phenobarbital or diazepam, are useful. These drugs should be discontinued over 5-10 days.

Patients who continue to experience seizures after the initial period of withdrawal should be treated with medications with low potential for abuse, such as phenytoin.

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Further Outpatient Care

Once abstinence has been established, focus care on returning the patient to the community in a manner in which recidivism is minimized.

Recurrence is likely unless access to solvent-inhalants is eliminated, social and familial dysfunction is remedied, and other psychiatric conditions, including depression and other substance abuse, are addressed and treated.

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Deterrence/Prevention

The nearly ubiquitous availability of organic solvents makes them poor candidates for governmental regulation to reduce abuse.

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Complications

Cardiac arrhythmias, including ventricular tachycardia, ventricular fibrillation, myocardial infarction, multifocal premature ventricular contractions and supraventricular tachycardia, have been observed.

Hypocalcemia is frequently encountered during fluid and electrolyte repletion and may be severe enough to precipitate tetany or seizures.

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Prognosis

Pulmonary, renal, GI, cardiac, and even neurologic dysfunction usually resolves with abstinence. Prolonged abuse increases the risk that residual organ dysfunction, particularly neurologic sequelae, will persist. Patients who abuse solvent-inhalants are frequently abusers of other drugs and alcohol.

Many abusers perform poorly in school, are chronically unemployed as adults, and commit criminal acts; therefore, efforts at early recognition and provision of long-term care with frequent monitoring are justified.

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Patient Education

Community education should be provided regarding the dangers of solvent-inhalant abuse. Education is considered to be the most effective preventive strategy, especially when it is initiated before the usual age of experimentation. School-based curricula that focus on deterring illicit drug use should include inhalants as potential drugs of abuse, and particular focus should be on areas where inhalant abuse is endemic. Pediatricians need to promote education about the health hazards posed by substance abuse to both patients and their families.[9]

For excellent patient education resources, visit eMedicine's Substance Abuse Center. Also, see eMedicine's patient education article Substance Abuse.

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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  MD, Assistant Professor of Pediatrics, Fellowship Director, Pediatric Critical Care, Golisano Children's Hospital at Strong

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 School of Medicine and Dentistry; 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.

Specialty Editor Board

Girish D Sharma, MD  Associate Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical 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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

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: Nothing to disclose.

References

  1. McHugh MJ. The abuse of volatile substances. Pediatr Clin North Am. Apr 1987;34(2):333-40. [Medline].

  2. Lyon RC, McComb JA, Schreurs J, et al. A relationship between alcohol intoxication and the disordering of brain membranes by a series of short-chain alcohols. J Pharmacol Exp Ther. Sep 1981;218(3):669-75. [Medline].

  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].

  8. Berkowitz FE, Booth WR. Glue-sniffing in a young child. S Afr Med J. Oct 7 1978;54(15):622. [Medline].

  9. Anderson CE, Loomis GA. Recognition and prevention of inhalant abuse. Am Fam Physician. Sep 1 2003;68(5):869-74. [Medline].

  10. King GS, Smialek JE, Troutman WG. Sudden death in adolescents resulting from the inhalation of typewriter correction fluid. JAMA. Mar 15 1985;253(11):1604-6. [Medline].

  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].

  12. Harris D, Mirza Z. Butane encephalopathy. Emerg Med J. Sep 2005;22(9):676-7. [Medline].

  13. Kuspis DA, Krenzelok EP. Oral frostbite injury from intentional abuse of a fluorinated hydrocarbon. J Toxicol Clin Toxicol. 1999;37(7):873-5. [Medline].

  14. Streicher HZ, Gabow PA, Moss AH, et al. Syndromes of toluene sniffing in adults. Ann Intern Med. Jun 1981;94(6):758-62. [Medline].

  15. Arnold GL, Kirby RS, Langendoerfer S, et al. Toluene embryopathy: clinical delineation and developmental follow-up. Pediatrics. Feb 1994;93(2):216-20. [Medline].

  16. Pearson MA, Hoyme HE, Seaver LH, et al. Toluene embryopathy: delineation of the phenotype and comparison with fetal alcohol syndrome. Pediatrics. Feb 1994;93(2):211-5. [Medline].

  17. Devathasan G, Low D, Teoh PC, et al. Complications of chronic glue (toluene) abuse in adolescents. Aust N Z J Med. Feb 1984;14(1):39-43. [Medline].

  18. Aydin K, Sencer S, Demir T, et al. Cranial MR findings in chronic toluene abuse by inhalation. AJNR Am J Neuroradiol. Aug 2002;23(7):1173-9. [Medline].

  19. Borne J, Riascos R, Cuellar H, et al. Neuroimaging in drug and substance abuse part II: opioids and solvents. Top Magn Reson Imaging. Jun 2005;16(3):239-45. [Medline].

  20. Rauber-Luthy C, Kupferschmidt H. Household chemicals: management of intoxication and antidotes. EXS. 2010;100:339-63. [Medline].

  21. Lorenc JD. Inhalant abuse in the pediatric population: a persistent challenge. Curr Opin Pediatr. Apr 2003;15(2):204-9. [Medline].

  22. Kurtzman TL, Otsuka KN, Wahl RA. Inhalant abuse by adolescents. J Adolesc Health. Mar 2001;28(3):170-80. [Medline].

  23. Wu LT, Pilowsky DJ, Schlenger WE. Inhalant abuse and dependence among adolescents in the United States. J Am Acad Child Adolesc Psychiatry. Oct 2004;43(10):1206-14. [Medline].

  24. Uzun N, Kendirli Y. Clinical, socio-demographic, neurophysiological and neuropsychiatric evaluation of children with volatile substance addiction. Child Care Health Dev. Jul 2005;31(4):425-32. [Medline].

  25. Dinwiddie SH. Abuse of inhalants: a review. Addiction. Aug 1994;89(8):925-39. [Medline].

  26. Ashton CH. Solvent abuse. BMJ. Jan 20 1990;300(6718):135-6. [Medline].

  27. Anderson HR, Macnair RS, Ramsey JD. Deaths from abuse of volatile substances: a national epidemiological study. Br Med J (Clin Res Ed). Jan 26 1985;290(6464):304-7. [Medline].

  28. Lowenstein LF. Recent research into glue-sniffing--extent of the problem its repercussions and treatment approaches. Int J Soc Psychiatry. Summer 1985;31(2):93-7. [Medline].

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

  30. 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].

  31. Broussard LA. The role of the laboratory in detecting inhalant abuse. Clin Lab Sci. Fall 2000;13(4):205-9. [Medline].

 
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Anteroposterior view of the chest of 14-month-old boy 30 hours after ingesting lamp oil. Note the central right lower lobe infiltrate obscuring the right heart border.
 
 
 
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