eMedicine Specialties > Neurology > Neurotoxicology

Inhalants: Follow-up

Author: Timothy Kaufman, MD, Staff Physician, Department of Emergency Medicine, Covenant Hospital, Saginaw Michigan
Coauthor(s): Edward C Jauch, MD, Faculty, Greater Cincinnati/Northern Kentucky Stroke Team, Associate Director of Research, Department of Emergency Medicine, Assistant Professor, University of Cincinnati College of Medicine; Rhonda S Cadena, MD, Staff Physician, Department of Emergency Medicine, University of Cincinnati College of Medicine
Contributor Information and Disclosures

Updated: Jul 9, 2007

Follow-up

Further Inpatient Care

  • Remember only those with significant inhalant-related complications are likely to reach the emergency department; these patients benefit from hospitalization for medical observation. In addition, psychiatric and social intervention is often necessary to prevent further abuse.
  • Although the acute intoxication may only last 15-45 minutes, drowsiness, disorientation, and stupor may persist for hours or even days, and chronic effects may last a lifetime.
  • ICU admission is certainly advised for any patient with hemodynamic instability, respiratory impairment, cardiac arrhythmias, or continued decreased level of consciousness. Close observation is necessary for worsening oxygenation and deterioration.

Further Outpatient Care

  • Appropriate drug intervention programs and psychological counseling should be arranged prior to discharging the patient.

Transfer

  • If a patient requires prolonged cardiac monitoring or medical intensive care but such facilities are not available at the hospital in which the patient is admitted, transfer the patient to an appropriate tertiary hospital.

Deterrence/Prevention

  • Risks and dangers of inhalant abuse should be explained to the patient. Dysfunctional family settings increase chances of return to inhalant use, and additional supervision may be required for these patients after discharge.

Complications

  • Complications of inhalant abuse include the following:

    • Cardiac - Sudden death, myocardial infarction, cardiac arrhythmias
    • Neurologic - Memory and cognitive impairment, blindness, psychosis, seizures, tetany
    • Pulmonary - Respiratory arrest, aspiration
    • Renal - Electrolyte disturbance, renal failure, hypocalcemia (particularly during fluid repletion)
    • Hepatic - Hepatic failure, hepatitis
    • Legal - Risk behaviors may lead to illegal activities or future forms of substance abuse.

Prognosis

  • In general, the prognosis for inhalant abuse is good if the pattern of abuse is recognized early. Significant morbidity is the rule in prolonged chronic abuse. The pulmonary, renal, cardiac, and gastrointestinal sequelae usually resolve with abstinence.

Patient Education

  • Patients and their parents need to be educated about inhalants and their devastating consequences. Education can occur through physician-patient discussion, referral to online resources, and third-party counseling on inhalant abuse. Adolescents have the legal right to receive confidential services for substance abuse, mental health, and reproductive health. Medical care providers can decide when parental involvement is appropriate and necessary.
  • To obtain further information, the following organizations may be contacted:
  • According to the National Inhalant Prevention Coalition (NIPC), treatment facilities for inhalant users are rare and difficult to find. A network of nationwide contacts exists through the NIPC, both for medical information and in locating treatment centers in the neighboring area.
  • For excellent patient education resources, visit eMedicine's Substance Abuse Center. Also, see eMedicine's patient education articles Drug Dependence and Abuse and Substance Abuse.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify inhalant abuse as a diagnosis
  • Failure to admit the patient for adequate observation and monitoring
  • Failure to recognize progressive pulmonary dysfunction following acute ingestion, because patients may experience rapid pulmonary decline, particularly with aspiration of the hydrocarbons

Special Concerns

  • Pregnancy, as described in History
 


More on Inhalants

Overview: Inhalants
Differential Diagnoses & Workup: Inhalants
Treatment & Medication: Inhalants
Follow-up: Inhalants
Multimedia: Inhalants
References
[ CLOSE WINDOW ]

References

  1. National Inhalant Prevention Coalition. National Inhalant Prevention Coalition Web site. [Full Text].

  2. American Heart Association. Handbook of Cardiac Care for Healthcare Providers. 1996:50-51, 94-95.

  3. Beauvais F, Oetting ER. Toward a clear definition of inhalant abuse. Int J Addict. Aug 1987;22(8):779-84. [Medline].

  4. Bowen SE, Daniel J, Balster RL. Deaths associated with inhalant abuse in Virginia from 1987 to 1996. Drug Alcohol Depend. Feb 1 1999;53(3):239-45. [Medline].

  5. Bowen SE, Hannigan JH. Developmental toxicity of prenatal exposure to toluene. AAPS J. 2006;8(2):E419-24. [Medline].

  6. Chepesiuk R. Resurgence of teen inhalant use. Environ Health Perspect. Dec 2005;113(12):A808. [Medline].

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

  8. Henretig F. Inhalant abuse in children and adolescents. Pediatr Ann. Jan 1996;25(1):47-52. [Medline].

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

  10. Linden CH. Volatile substances of abuse. Emerg Med Clin North Am. Aug 1990;8(3):559-78. [Medline].

  11. Lowinson J, Ruiz P. Volatile substances. In: Sharp CW and Rosenberg NL, eds. Substance Abuse. 1992:303-327.

  12. McGarvey EL, Clavet GJ, Mason W, Waite D. Adolescent inhalant abuse: environments of use. Am J Drug Alcohol Abuse. Nov 1999;25(4):731-41. [Medline].

  13. McGuinness TM. Nothing to sniff at: inhalant abuse & youth. J Psychosoc Nurs Ment Health Serv. Aug 2006;44(8):15-8. [Medline].

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

  15. Miller NS, Gold MS. Organic solvent and aerosol abuse. Am Fam Physician. Jul 1991;44(1):183-9. [Medline].

  16. Muller AA, Muller GF. Inhalant abuse. J Emerg Nurs. Oct 2006;32(5):447-8. [Medline].

  17. Muller, AA, Muller, GF. Inhalant abuse. J Emerg Nurs. 2006;32:447-8. [Medline].

  18. National Institute on Drug Abuse. Student Drug Use Attitudes and Beliefs: National Trends, 1975-1982. US Government Printing Office; 1982.

  19. US Dept of Health and Human Services. 2001 Monitoring the Future Survey. HHS News; [Full Text].

  20. Wu LT, Schlenger WE, Ringwalt CL. Use of nitrite inhalants ("poppers") among American youth. J Adolesc Health. Jul 2005;37(1):52-60. [Medline].

  21. Young SJ, Longstaffe S, Tenenbein M. Inhalant abuse and the abuse of other drugs. Am J Drug Alcohol Abuse. May 1999;25(2):371-5. [Medline].

  22. Cruz SL, Orta-Salazar G, Gauthereau MY, Millan-Perez Peña L, Salinas-Stefanón EM. Inhibition of cardiac sodium currents by toluene exposure. Br J Pharmacol. Oct 2003;140(4):653-60. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

sniffing, huffing, bagging, inhaling, solvents, aerosols, adhesives, fuels, dry-cleaning agents, tape-head cleaners, correction fluid, propellants, inhalant abuse, volatile chemicals, alkyl nitrites, aromatics, benzene, methylene chloride, inhalant intoxication, inhalant agents

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Timothy Kaufman, MD, Staff Physician, Department of Emergency Medicine, Covenant Hospital, Saginaw Michigan
Timothy Kaufman, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Edward C Jauch, MD, Faculty, Greater Cincinnati/Northern Kentucky Stroke Team, Associate Director of Research, Department of Emergency Medicine, Assistant Professor, University of Cincinnati College of Medicine
Edward C Jauch, MD is a member of the following medical societies: American College of Emergency Physicians, American Heart Association, American Medical Association, National Stroke Association, Ohio State Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Rhonda S Cadena, MD, Staff Physician, Department of Emergency Medicine, University of Cincinnati College of Medicine
Rhonda S Cadena, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Medical Editor

Jonathan S Rutchik, MD, MPH, Assistant Professor, Department of Occupational and Environmental Medicine, University of California at San Francisco
Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology and Association of American Physicians and Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor of Neurology, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida College of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.