Further Inpatient Care
- Consider admitting patients with toluene exposure or abuse for observation and treatment if they have electrolyte abnormalities, cardiovascular problems, hypoxia, seizures, rhabdomyolysis, or persistent mental status changes.
- Patients with continuing respiratory, cardiac, and renal problems may need to be admitted to the critical care unit.
Further Outpatient Care
- Workers with occupational exposures and patients who are not chronic abusers, without laboratory abnormalities, and who demonstrate improved mental status (asymptomatic, back to baseline) may be discharged from the ED after 4-6 hours of observation.
- Arrange for follow-up care with the primary care physician within 1-3 days.
- Advise patients and families to return to the ED if changes in mental status, decreased urine output, abdominal pain, muscle pain or weakness, shortness of breath, chest pain, or choking sensation occurs.
- Arrange substance abuse counseling for abusers, although recidivism is extremely high.
- Refer long-term abusers with no laboratory abnormalities and improved mental status to a drug rehabilitation program.
Inpatient & Outpatient Medications
- No specific medication is warranted for further treatment of patients.
Transfer
- Transfer patients to a facility with critical care if they require critical care monitoring and are admitted to a hospital without sufficient ICU facilities.
Deterrence/Prevention
- Advise workers with occupational exposure not to work in poorly ventilated enclosed rooms.
- Inform chronic glue sniffers of the long-term sequelae and consequences associated with abuse.
Complications
Complications of toluene toxicity are listed below:
- CNS complications
- Neuropsychosis
- Cerebellar ataxia
- Cognitive impairment, dementia
- Tremors
- Neuropathies
- Blindness
- Deafness
- Sudden death resulting from cardiac arrhythmias
- Respiratory depression, hypoxia, bronchospasm, acute lunge injury, and aspiration pneumonitis
- Hepatotoxicity
- Hepatic reticuloendothelial failure (HREF)
- Ascites
- Jaundice
- Liver failure
- Renal tubular acidosis, renal stones, hematuria, proteinuria, electrolyte disturbances, and acute renal failure
- Abdominal pain, hematemesis, and vomiting
- Muscle pain and weakness, rhabdomyolysis, and myoglobinemia
- Contact dermatitis (defatting hydrocarbon dermatitis), chemical burns, and coagulation necrosis
- Epistaxis, nasal ulcerations, and chronic rhinitis
Prognosis
- Prognosis is good if patients receive appropriate counseling and follow-up and are compliant with recommendations.
- Prognosis is poor in patients who continue to abuse toluene.
Patient Education
- Inform patients of the consequences of toluene abuse.
- Advise patients of opportunities for counseling, therapy, and detoxification.
- For excellent patient education resources, visit eMedicine's Substance Abuse Center. Also, see eMedicine's patient education article Substance Abuse.
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