Inhalants Follow-up

  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Tarakad S Ramachandran, MBBS, FRCP(C), FACP   more...
 
Updated: Sep 2, 2010
 

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.
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Further Outpatient Care

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

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Transfer

If a patient requires prolonged cardiac monitoring or medical intensive care, but such facilities are not locally available, transfer to an appropriate tertiary hospital is indicated.

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Deterrence/Prevention

Public education remains important, especially targeting at-risk groups. Individually, the 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.

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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.
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Prognosis

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

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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:
    • National Clearinghouse for Alcohol and Drug Information
    • PO Box 2345
    • Rockville, MD 20847-2345
    • Phone: (800) 729-6686
    • National Institute on Drug Abuse (NIDA)
    • 6001 Executive Boulevard, Room 5213
    • Bethesda, MD 20892-9561
    • Phone: (301) 442-1124
    • National Inhalant Prevention Coalition (NIPC)
    • 506 Barton Avenue
    • Chattanooga, TN 37405
    • Phone: (800) 269-4237 or (423) 265-4662
    • Fax: (423) 265-4889
    • e-mail: nipc@io.com
  • 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.
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Contributor Information and Disclosures
Author

Edward C Jauch, MD, MS, FAHA, FACEP  Professor, Division of Emergency Medicine and Department of Neurosciences, Medical University of South Carolina

Edward C Jauch, MD, MS, FAHA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Heart Association, American Medical Association, National Stroke Association, Society for Academic Emergency Medicine, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Rhonda S Cadena, MD  Assistant Professor, Department of Emergency Medicine and Neurovascular Emergencies and Critical Care Fellow

Rhonda S Cadena, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Jamie Do Kuo, MD  Resident Physician, Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston

Jamie Do Kuo, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jonathan S Rutchik, MD, MPH  Clinical Professor, Division of Occupational Medicine, Department of Neurology, Environmental and Occupational Medicine, University of California, San Francisco, School of Medicine

Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, and Society of Toxicology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

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: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP  Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Timothy Kaufman, MD to the development and writing of this article.

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This young man was huffing green spray paint. Note the presence of the paint on his hands and face.
This picture shows a close-up of the face of a young man who had been huffing green spray paint.
 
 
 
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