Medscape is available in 5 Language Editions – Choose your Edition here.


Toluene Toxicity Clinical Presentation

  • Author: Nathanael J McKeown, DO; Chief Editor: Asim Tarabar, MD  more...
Updated: Feb 01, 2015


Identifying toluene exposure or risk of exposure admission is important, as well as the route of exposure, whether inhalation, ingestion, or transdermal absorption. Any history of "huffing" or "bagging" before presentation, or a history of previous abuse of inhalants, should be elicited.

An occupational history should be taken, to identify workers whose occupation may result in nonintentional acute or chronic exposure. Examples of workers who may be at risk include the following:

  • Painters
  • Chemists
  • Textile workers
  • Gasoline refinery workers
  • Rubber industry workers

Hobbies or activities that lead to nonintentional or intentional exposure should be reviewed. Model airplane glues and rubber cements are sources of toluene. Varnishes may affect people refinishing wooden furniture.

Toxicities and risks vary with the route of exposure, as follows:

  • Ingestion may cause hematemesis and abdominal pain
  • Inhalation is a risk for airway compromise secondary to aspiration and induction of bronchospasm; subsequent hypoxemia from chemical pneumonitis and acute lung injury also may occur
  • Cutaneous exposure may result in coagulation necrosis unless copious skin irrigation is performed

The history should also identify any other drugs that may be in the patient's system, including alcohol, cocaine, and marijuana. Alcohol intoxication and toluene intoxication have a similar presentations. Alcohol inhibits the metabolism of toluene and raises the concentration of toluene in the blood twofold. Cocaine, or any sympathomimetic use, may increase risks of fatal arrhythmias.



Physical examination is an important aid in confirming a suspected diagnosis of toluene poisoning. Patients with acute toluene poisoning may present with a range of pulmonary and central nervous system (CNS) symptoms, depending on duration of exposure, route of exposure, and level of toluene in the air or liquid.

Patients with chronic exposure may present with wide variety of complaints.

General /vital sign manifestations include the following:

  • Patients may be tachypneic, tachycardic, and hypoxic on initial evaluation
  • Hypotension may be present
  • Fever may be present, secondary to aspiration pneumonitis
  • Sweet smelling odor: Hair, breath, and clothing may smell of solvent; 20% of inhaled toluene is expired from the lungs unchanged
  • Paint or oil stains may be seen on clothing

Head, eyes, ears, nose, and throat (HEENT) manifestations include the following:

  • "Huffer's eczema": Perioral defatting dermatitis secondary to contact of solvent vapors with skin may be noted
  • Mucosal irritation (eg, burning mouth, eyes, throat)
  • Injected sclera
  • Nystagmus

Neurologic manifestations are as follows:

  • Decreased level of consciousness leading to coma
  • Dizziness and headaches
  • Confusion
  • Hallucinations
  • Amnesia
  • Seizure activity
  • Paresthesias (Toluene has anesthetic effects.)
  • Decreased deep tendon reflexes

Cerebellar signs include the following:

  • Decreased motor coordination
  • Impaired fine motor movements
  • Ataxia
  • Balance problems
  • Anesthesia

Pulmonary manifestations include the following:

  • Respiratory distress
  • Dyspnea
  • Chest pain (with aspiration)
  • Tachypnea
  • Cyanosis
  • Wheezing from bronchospasm

Gastrointestinal manifestations include the following:

  • Nausea
  • Vomiting
  • Abdominal pain
  • Hematemesis
  • Jaundice

Dermatologic manifestations include the following:

  • Itching or burns from skin contact
  • Glue sniffer's rash (see in HEENT)

Musculoskeletal manifestations include the following:

  • Profound muscle weakness due to hypokalemia
  • Muscle pain


Inhalation of airborne toluene is the most common cause of exposure. Exposure can occur in several occupations, including paint workers, dye makers, and workers in the chemical and petrochemical industry.

Toluene toxicity can occur from the following:

  • Nonintentional or deliberate inhalation of fumes
  • Ingestion
  • Absorption through the skin

Toluene is found in the following:

  • Gasoline
  • Acrylic paints
  • Varnishes
  • Lacquers
  • Paint thinners
  • Adhesives
  • Glues
  • Rubber cement
  • Airplane glue
  • Shoe polish
  • Typewriter erasing fluid
Contributor Information and Disclosures

Nathanael J McKeown, DO Assistant Professor, Department of Emergency Medicine, Oregon Health and Science University School of Medicine; Medical Toxicologist, Oregon Poison Center; Attending Physician, Emergency Medicine, Portland Veteran Affairs Medical Center

Nathanael J McKeown, DO is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP Attending Physician in Emergency Medicine, Excela Health System

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

Debra Slapper, MD Physician, Southwest Washington Free Clinic System-Urgent Care; Former FEMA Physician and Military Contractor; Former Associate Professor, University of Miami, Leonard M Miller School of Medicine and University of South Florida Morsani College of Medicine

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Kevin A Martin, MD, to the development and writing of this article.

  1. United States Department of Labor. Occupational Safety and Health Administration. Safety and Health topics: Toluene. Last revised March 17, 2004. Available at:

  2. Broberg K, Tinnerberg H, Axmon A, Warholm M, Rannug A, Littorin M. Influence of genetic factors on toluene diisocyanate-related symptoms: evidence from a cross-sectional study. Environ Health. 2008 Apr 30. 7:15. [Medline].

  3. Cruz SL, Rivera-García MT, Woodward JJ. Review of toluene action: clinical evidence, animal studies and molecular targets. J Drug Alcohol Res. 2014. 3:[Medline]. [Full Text].

  4. Shiomi S, Kuroki T, Kuroda T, et al. Absence of hepatic uptake of Tc-99m phytate in a man with chronic toluene hepatotoxicity. Clin Nucl Med. 1993 Aug. 18(8):655-6. [Medline].

  5. Atay AA, Kismet E, Turkbay T, Kocaoglu M, Demirkaya E, Sarici SU, et al. Bone mass toxicity associated with inhalation exposure to toluene. Biol Trace Elem Res. 2005 Summer. 105(1-3):197-203. [Medline].

  6. United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2012 National Survey on Drug Use and Health: National Survey. Sept 2008. Available at: [Full Text].

  7. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila). 2014 Dec. 52(10):1032-283. [Medline]. [Full Text].

  8. Flanagan RJ, Ruprah M, Meredith TJ, Ramsey JD. An introduction to the clinical toxicology of volatile substances. Drug Saf. 1990 Sep-Oct. 5(5):359-83. [Medline].

  9. Medina-Mora ME, Real T. Epidemiology of inhalant use. Curr Opin Psychiatry. 2008 May. 21(3):247-51. [Medline].

  10. Chao TC, Lo DS, Koh J, et al. Glue sniffing deaths in Singapore--volatile aromatic hydrocarbons in post-mortem blood by headspace gas chromatography. Med Sci Law. 1993 Jul. 33(3):253-60. [Medline].

  11. Seth R, Kotwal A, Ganguly KK. Street and working children of Delhi, India, misusing toluene: an ethnographic exploration. Subst Use Misuse. 2005. 40(11):1659-79. [Medline].

  12. White V, Hayman J. Australian secondary students’ use of over-the-counter and illicit substances in 2002. 2004.

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

  14. Pearson MA, Hoyme HE, Seaver LH, Rimsza ME. Toluene embryopathy: delineation of the phenotype and comparison with fetal alcohol syndrome. Pediatrics. 1994 Feb. 93(2):211-5. [Medline].

  15. Wick R, Gilbert JD, Felgate P, Byard RW. Inhalant deaths in South Australia: a 20-year retrospective autopsy study. Am J Forensic Med Pathol. 2007 Dec. 28(4):319-22. [Medline].

  16. Toluene. Baselt RC, ed. Disposition of Toxic Drugs and Chemicals in Man. 7th ed. Foster City, CA: Biomedical Publications; 2004. 1120-24.

  17. Cámara-Lemarroy CR, Gónzalez-Moreno EI, Rodriguez-Gutierrez R, González-González JG. Clinical presentation and management in acute toluene intoxication: a case series. Inhal Toxicol. 2012 Jun. 24(7):434-8. [Medline].

  18. Ellenhorn MJ, Schonwald S, Ordog G. Inhalant abuse. Ellenhorn's Medical Toxicology. 2nd ed. Lipincott Williams & Wilkins: 1997. 1493-5.

  19. Gagnaire F, Langlais C. Relative ototoxicity of 21 aromatic solvents. Arch Toxicol. 2005 Jun. 79(6):346-54. [Medline].

  20. Siqueira LM, Crandall LA. Inhalant use in Florida youth. Subst Abus. 2006 Dec. 27(4):27-35. [Medline].

  21. Woodward JJ, Beckley J. Effects of the abused inhalant toluene on the mesolimbic dopamine system. J Drug Alcohol Res. 2014. 3:[Medline]. [Full Text].

  22. Yucel M, Takagi M, Walterfang M, Lubman DI. Toluene misuse and long-term harms: a systematic review of the neuropsychological and neuroimaging literature. Neurosci Biobehav Rev. 2008 Jul. 32(5):910-26. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.