Inhalants Treatment & Management

  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Tarakad S Ramachandran, MBBS, FRCP(C), FACP   more...
 
Updated: Apr 16, 2012
 

Medical Care

Appropriate medical care for the inhalant-abusing patient is dictated by the severity of injury and the setting of care. The following medical care is recommended for patients with acute intoxication.

  • Prehospital care: The ABCs start by securing the patient's airway, breathing, and circulation. Follow standard ACLS protocols, keeping in mind that inhalant-abuse patients may experience hallucinations and become combative. Restraints should be applied carefully, if at all, and in accordance with local policy. Sufficient personnel should assist with moving the patient to the hospital to ensure the safety of both the patient and the EMS crew. If saturated with solvent, the patient's clothing should be removed to prevent worsening intoxication and to protect EMS personnel. Supply supplemental oxygen and obtain IV access if appropriate.
  • Emergency department care begins by protecting the patient's airway as dictated by level of consciousness and the ability of the patient to control their airway. Intubation may be required, so have appropriate equipment and personnel available. Place the patient on supplemental oxygen. Cautiously treat bronchospasm (if present) with aerosolized beta-agonists, bearing in mind that these agents may induce arrhythmias in the inhalant-sensitized heart. If severe bronchospasm is present, systemic steroids (in doses similar to those used with acute asthma exacerbations) can be helpful.
    • Obtain intravenous access and begin cardiac monitoring. Treat hypotension with supine patient positioning and intravenous fluid boluses. Use catecholamine pressors if necessary, but remember that these agents also cause cardiac sensitization and are proarrhythmic. Severe patient agitation should be treated with benzodiazepines or haloperidol (recognizing that haloperidol may decrease underlying seizure thresholds). Remember that sudden death in these patients often involves sudden or strenuous activity; therefore, minimize patient agitation as much as possible.
    • Measure electrolytes, including potassium, calcium, and phosphorus and replete as necessary because abnormal values can exacerbate cardiac dysrhythmias and muscle weakness.
    • GI decontamination is generally not recommended unless co-ingestion is suspected, in which case, activated charcoal or an electrolyte solution (eg, GoLYTELY) may be indicated.
    • Specific laboratory tests and antidotes may be indicated for the following volatiles:
      • Methylene chloride: Check carboxyhemoglobin level, use 100% nonrebreather oxygen, and consider hyperbaric oxygen treatment for the critically ill. These patients require prolonged monitoring and treatment (at least 12-24 h), because the carbon monoxide level resolves more slowly than in inhaled carbon monoxide poisoning.
      • Alkyl nitrites: Check serum methemoglobin levels. For levels more than 30% in symptomatic patients, administer methylene blue, 1-2 mg/kg IV over 5 minutes; repeat in 30-60 minutes as necessary. Total dose should not exceed 7 mg/kg to prevent a promethemoglobin paradoxical effect.
      • Carbon tetrachloride: Consider hepatic injury and necrosis. Experimental evidence supports use of N -acetyl-cysteine (NAC), charcoal hemoperfusion, and hyperbaric oxygen.
      • Gasoline: Chronic gasoline sniffing formerly was associated with lead poisoning; thus, lead testing might be warranted. Gasoline sold in the United States today is generally unleaded. Check blood lead level if appropriate and treat elevated levels accordingly with chelating agents.
      • Long-term abusers should be referred for psychiatric evaluation and treatment. Although there is no proven method of inhalant abuse treatment, a case study by Shen was successful in treating inhalant abuse with lamotrigine, an anticonvulsant that inhibits the excitatory amino acid glutamate.[9]
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Consultations

  • Consulting a toxicologist or a local poison control center for any acute inhalant intoxication is appropriate and encouraged.
  • A cardiologist should be consulted if ventricular arrhythmias are present and persistent.
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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.

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 Medscape Reference gratefully acknowledge the contributions of previous authors Timothy Kaufman, MD and Jamie Do Kuo, 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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