Inhalants Follow-up

Updated: May 05, 2017
  • Author: Nicholas J Connors, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Follow-up

Further Outpatient Care

Appropriate drug intervention programs and psychological counseling should be arranged prior to discharging the patient. Since withdrawal symptoms are relieved with inhalant re-exposure, addictive patterns may develop and should be addressed through counseling. [12]

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Further Inpatient Care

Remember only those with significant inhalant-related complications are likely to reach the ED; 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.

Acute withdrawal management may be managed with benzodiazepines. [11]

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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 - Acute and/or permanent memory and cognitive impairment, blindness, psychosis, seizures, tetany, weakness, numbness, paresthesias

  • Pulmonary - Respiratory arrest, aspiration, chemical pneumonitis

  • Renal - Electrolyte disturbance, renal failure, hypocalcemia (particularly during fluid repletion)

  • Hepatic - Hepatic failure, hepatitis

  • Psychiatric – Inhalant abuse is associated with increased rates of suicidal ideation and suicidal attempts (minor and severe) [13]

  • Legal - Risk behaviors may lead to illegal activities or other 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. In a review of toluene abuse, long-term use produces white matter changes in the brain resulting in dementia. [8] 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 patient education resources, see the Substance Abuse Center, as well as Drug Dependence and Abuse and Substance Abuse.

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