Hydrocarbon Inhalation Injury Treatment & Management
- Author: Rakesh Vadde, MBBS; Chief Editor: Michael R Bye, MD more...
The care of patients with inhalation abuse is mainly supportive. Because many potential complications involving the pulmonary, cardiovascular, and neurologic systems may be present, careful assessment and stabilization of the ABCs should be paramount in the initial management. In addition to acute medical treatment, patients suspected of chronic solvent-inhalant use should be carefully evaluated by a team trained in the treatment of childhood substance abuse.
Acute inhalant abuse
Medical care of patients following acute decompensation from hydrocarbon inhalation is primarily supportive. Those with significant neurologic impairment who are unable to protect their airway should undergo endotracheal intubation and mechanical ventilation to prevent aspiration and respiratory deterioration. Hypoxic injury to other organ systems, particularly the heart, should be sought and treated.
Because of the sensitization of the myocardium to catecholamines, inotropic agents and bronchodilators should be avoided. Some authors suggest the use of amiodarone to treat ventricular arrhythmias if used early in treatment. Epinephrine administration during resuscitation may be harmful and can lead to recurrence of ventricular fibrillation.
Electrolyte abnormalities should be corrected.
Chronic inhalant abuse
Management of chronic solvent-inhalant abuse should be directed at preventing further abuse.
Therapy for commonly involved organs, including the central and peripheral nervous systems, kidneys, liver, lungs, heart, and bone marrow, is primarily supportive.
In patients with significant electrolyte abnormalities, typically due to distal renal tubular acidosis, parenteral fluid and electrolyte repletion may be necessary. Correction of potassium and phosphorus deficiency may result in rapid improvement in muscle strength. Hypocalcemia is frequently encountered during fluid and electrolyte repletion.
Apneic aversion and covert sensitization have been used as a treatment of hydrocarbon inhalation addiction.
Patients who are suspected of solvent-inhalant abuse should be carefully evaluated by experts who are trained in the treatment of childhood substance abuse. Consultation with specialists, including cardiologists and neurologists, may also be warranted, depending on the individual needs of the patient. Any patient who has unstable hemodynamics or cardiac arrhythmias or who has significantly altered mental status should be admitted to and observed in the pediatric intensive care unit.
Patients should remain on a diet of nothing by mouth (NPO) until muscle weakness clearly will not necessitate institution of mechanical ventilation. Also, because of the risk of hypocalcemic seizures, patients should remain NPO during initial fluid and electrolyte repletion.
McHugh MJ. The abuse of volatile substances. Pediatr Clin North Am. 1987 Apr. 34(2):333-40. [Medline].
Phatak DR, Walterscheid J. Huffing air conditioner fluid: a cool way to die?. Am J Forensic Med Pathol. 2012 Mar. 33(1):64-7. [Medline].
US Consumer Product Safety Commisson. CPSC Requires Child-Resistant Packaging for Common Household Products Containing Hydrocarbons, Including Some Baby Oils. Available at http://www.cpsc.gov/en/Newsroom/News-Releases/2002/CPSC-Requires-Child-Resistant-Packaging-for-Common-Household-Products-Containing-Hydrocarbons-Including-Some-Baby-Oils/. Accessed: April 11, 2014.
Mahmoodpoor A, Soleimanpour H, Hamishehkar H. Multi organ failure following intravenous gasoline for suicide: a case report. Acta Med Iran. 2012. 50(12):846-8. [Medline].
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. 1981 Sep. 218(3):669-75. [Medline].
Jones HE, Balster RL. Inhalant abuse in pregnancy. Obstet Gynecol Clin North Am. 1998 Mar. 25(1):153-67. [Medline].
Bass M. Sudden sniffing death. JAMA. 1970 Jun 22. 212(12):2075-9. [Medline].
LoVecchio F, Fulton SE. Ventricular fibrillation following inhalation of Glade Air Freshener. Eur J Emerg Med. 2001 Jun. 8(2):153-4. [Medline].
Edwards KE, Wenstone R. Successful resuscitation from recurrent ventricular fibrillation secondary to butane inhalation. Br J Anaesth. 2000 Jun. 84(6):803-5. [Medline].
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. 2005 Jun. 12(3):137-41. [Medline].
Berkowitz FE, Booth WR. Glue-sniffing in a young child. S Afr Med J. 1978 Oct 7. 54(15):622. [Medline].
Anderson CE, Loomis GA. Recognition and prevention of inhalant abuse. Am Fam Physician. 2003 Sep 1. 68(5):869-74. [Medline].
King GS, Smialek JE, Troutman WG. Sudden death in adolescents resulting from the inhalation of typewriter correction fluid. JAMA. 1985 Mar 15. 253(11):1604-6. [Medline].
Frangides CY, Tzortzatos GV, Koulouras V, et al. Acute massive rhabdomyolysis due to prolonged inhalation of liquid gas. Eur J Emerg Med. 2003 Mar. 10(1):44-6. [Medline].
Harris D, Mirza Z. Butane encephalopathy. Emerg Med J. 2005 Sep. 22(9):676-7. [Medline].
Kuspis DA, Krenzelok EP. Oral frostbite injury from intentional abuse of a fluorinated hydrocarbon. J Toxicol Clin Toxicol. 1999. 37(7):873-5. [Medline].
Streicher HZ, Gabow PA, Moss AH, et al. Syndromes of toluene sniffing in adults. Ann Intern Med. 1981 Jun. 94(6):758-62. [Medline].
Arnold GL, Kirby RS, Langendoerfer S, et al. Toluene embryopathy: clinical delineation and developmental follow-up. Pediatrics. 1994 Feb. 93(2):216-20. [Medline].
Pearson MA, Hoyme HE, Seaver LH, et al. Toluene embryopathy: delineation of the phenotype and comparison with fetal alcohol syndrome. Pediatrics. 1994 Feb. 93(2):211-5. [Medline].
Devathasan G, Low D, Teoh PC, et al. Complications of chronic glue (toluene) abuse in adolescents. Aust N Z J Med. 1984 Feb. 14(1):39-43. [Medline].
Aydin K, Sencer S, Demir T, et al. Cranial MR findings in chronic toluene abuse by inhalation. AJNR Am J Neuroradiol. 2002 Aug. 23(7):1173-9. [Medline].
Borne J, Riascos R, Cuellar H, et al. Neuroimaging in drug and substance abuse part II: opioids and solvents. Top Magn Reson Imaging. 2005 Jun. 16(3):239-45. [Medline].
Rauber-Luthy C, Kupferschmidt H. Household chemicals: management of intoxication and antidotes. EXS. 2010. 100:339-63. [Medline].
Weibrecht KW, Rhyee SH. Acute respiratory distress associated with inhaled hydrocarbon. Am J Ind Med. 2011 Dec. 54(12):911-4. [Medline].
Lorenc JD. Inhalant abuse in the pediatric population: a persistent challenge. Curr Opin Pediatr. 2003 Apr. 15(2):204-9. [Medline].
Kurtzman TL, Otsuka KN, Wahl RA. Inhalant abuse by adolescents. J Adolesc Health. 2001 Mar. 28(3):170-80. [Medline].
Wu LT, Pilowsky DJ, Schlenger WE. Inhalant abuse and dependence among adolescents in the United States. J Am Acad Child Adolesc Psychiatry. 2004 Oct. 43(10):1206-14. [Medline].
Driscoll DL, Dotterrer B, Collins D, Ogilvie K, Grube J, Johnson K. Demographic and contextual factors associated with inhalant use among youth in rural Alaska. Int J Circumpolar Health. 2012 Apr 16. 71:1-4. [Medline]. [Full Text].
Uzun N, Kendirli Y. Clinical, socio-demographic, neurophysiological and neuropsychiatric evaluation of children with volatile substance addiction. Child Care Health Dev. 2005 Jul. 31(4):425-32. [Medline].
Dinwiddie SH. Abuse of inhalants: a review. Addiction. 1994 Aug. 89(8):925-39. [Medline].
National Institute of Drug Abuse. DrugFacts: Inhalants. Available at http://www.drugabuse.gov/sites/default/files/dfinhalants_1.pdf. Accessed: April 11, 2014.
Ashton CH. Solvent abuse. BMJ. 1990 Jan 20. 300(6718):135-6. [Medline].
Anderson HR, Macnair RS, Ramsey JD. Deaths from abuse of volatile substances: a national epidemiological study. Br Med J (Clin Res Ed). 1985 Jan 26. 290(6464):304-7. [Medline].
Lowenstein LF. Recent research into glue-sniffing--extent of the problem its repercussions and treatment approaches. Int J Soc Psychiatry. 1985 Summer. 31(2):93-7. [Medline].
Baird CA, Furek MW. Adolescents and inhalant abuse: how huffing affects the myelin sheath. J Addict Nurs. 2012 May. 23(2):129-31. [Medline].
Westermeyer J. The psychiatrist and solvent-inhalant abuse: recognition, assessment, and treatment. Am J Psychiatry. 1987 Jul. 144(7):903-7. [Medline].
Padilla ER, Padilla AM, Morales A, et al. Inhalant, marijuana, and alcohol abuse among barrio children and adolescents. Int J Addict. 1979 Oct. 14(7):945-64. [Medline].
Broussard LA. The role of the laboratory in detecting inhalant abuse. Clin Lab Sci. 2000 Fall. 13(4):205-9. [Medline].
Blanchard EB, Libet JM, Young LD. Apneic aversion and covert sensitization in the treatment of a hydrocarbon inhalation addiction: A case study. J Behav Ther Experimental Psych. December 1973. 4:383–87.