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Hydrocarbon Inhalation Injury Follow-up

  • Author: Rakesh Vadde, MBBS; Chief Editor: Michael R Bye, MD  more...
 
Updated: Apr 18, 2014
 

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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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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Deterrence/Prevention

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

Preteens are at risk of inhalant abuse; therefore, evidence-based in-school primary prevention education must begin early to ensure that its messages have been delivered before—not in the midst of—youth inhalant abuse. Office-based brief interventions that include a 5- to 10-minute session outlining the risks associated with substance use have been found to be effective in reducing alcohol, marijuana, and tobacco use. However, similar strategies have not been shown to be effective for inhalant abuse, in which perceptions of harm are more strongly correlated with social networks than with future intent to use inhalants. Availability and use of inhalants by peers correlate with inhalant abuse, with many youths reporting abuse at friends’ homes and on school property.[40]

In addition, inhalant abuse is correlated with poverty, hunger, illness, low education levels, unemployment, boredom, and feelings of hopelessness. Thus, it is clear that prevention must also address the influence of social factors, including the social determinants of health. Intersectoral action that includes partnerships among community agencies, the private sector, and government is required to disseminate information and education on inhalant abuse and to develop policies that address inhalant abuse prevention.[40]

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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

Health professionals should use their knowledge, experience, and community connections to achieve the following[40] :

  • Play a guiding role in creating a network of health and community care for inhalant abusers
  • Guide policy regarding inhalant abuse prevention education and treatment
  • Ensure the social determinants of health affecting inhalant abuse are understood and considered in policy
  • Advocate for the replacement of dangerous and psychoactive substances in common products with less harmful alternatives
  • Advocate for and contribute to research that increases the understanding of inhalant abuse, including epidemiology and effective prevention and treatment strategies that address social factors

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.[12]

For excellent patient education resources, see eMedicineHealth's patient education article Substance Abuse.

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Contributor Information and Disclosures
Author

Rakesh Vadde, MBBS Fellow in Pulmonary Medicine, Interfaith Medical Center

Rakesh Vadde, MBBS is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

M Frances J Schmidt, MD Chief of Pulmonary Medicine, Pulmonary Fellowship Program, Teaching Attending Physician, Department of Medicine, Interfaith Medical Center

M Frances J Schmidt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Divya Salhan, MD Resident Physician, Department of Internal Medicine, Interfaith Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler 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, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

Emily B Nazarian, 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.

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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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