Toluene Toxicity Workup

  • Author: Nathanael J McKeown, DO; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 11, 2011
 

Laboratory Studies

Arterial blood gas (ABG) measurements indicate acidosis, hypoxemia, and hypercarbia.

Measure serum electrolytes and glucose levels. Toluene exposure may cause hypokalemia, hyperchloremia, metabolic acidosis, hypocalcemia, and hypophosphatemia. Hypoglycemia must be ruled out as a cause of decreased mental status.

Blood urea nitrogen (BUN) and creatinine levels are necessary to monitor kidney function because toluene can cause renal failure.

Obtain urine or serum creatinine kinase (CK) and myoglobin measurements to test for rhabdomyolysis from toluene-induced muscle damage, which may contribute to renal failure.

Serum toluene concentrations are available only through specialized laboratories and are not available quickly enough to guide therapy.[17] Blood toluene levels of 2.5 mg/L correlate with toxicity. Levels of 50 mg/L are probably fatal.

Perform toxicological screens to test for alcohol, acetaminophen, cocaine, and salicylates levels.

  • Alcohol can cause similar mental status changes to toluene and can increase serum toluene levels and decrease its metabolism.
  • Salicylates may cause metabolic acidosis.
  • Cocaine may worsen cardiac arrhythmias.

Liver enzymes and bilirubin levels measure hepatotoxic effects, which may cause jaundice, hepatitis, and liver failure.

A CBC with differential and peripheral blood smear test results may detect many hematologic effects. Patients need to be monitored for anemia, leucocytosis, and abnormalities of blood elements.

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Imaging Studies

A chest radiograph may show aspiration pneumonitis or acute lung injury.

In patients with chronic exposure to toluene, a CT scan of the head may show cerebral cortex and cerebellar atrophy with brainstem atrophy in severe cases.

An MRI may reveal cerebral cortex, cerebellar, and brainstem atrophy with sulcal widening and ventricular dilation. Increased periventricular white matter and loss of differentiation of gray and white matter may also be observed.

Technetium Tc 99m radionucleotide scan of the liver may show a rare form of hepatotoxicity secondary to toluene exposure. In hepatic reticuloendothelial failure (HREF), a decreased uptake of the radionucleotide suggesting impaired liver function occurs.[5]

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Other Tests

ECG is an essential test because toluene-induced arrhythmias, including ventricular fibrillation, often are responsible for the sudden death associated with poisoning.

Cardiac monitoring of patients should be continuous during observation so that any dysrhythmias may be detected promptly.

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Contributor Information and Disclosures
Author

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Debra Slapper, MD  Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital

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

Disclosure: Nothing to disclose.

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  Director of Medical Toxicology, Allegheny General Hospital

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

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

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

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