Use of volatile solvents (eg, acetates, alcohol, chloroform, ether, aliphatic and aromatic hydrocarbons, chlorinated hydrocarbons, ketones) continues to be an endemic problem among adolescents. Common commercial products (eg, glues and adhesives, paints, paint strippers, cleaning fluids) contain these substances; thus, children and adolescents can easily obtain them. About 10% of adolescents in the US have reportedly inhaled volatile solvents. Typically, a solvent-soaked rag is placed in a bag or container that is held to the mouth and nose; the naturally volatilized vapors are then inhaled (huffing, sniffing).
Volatile solvents temporarily stimulate the central nervous system before depressing it. Partial tolerance and psychologic dependence develop with frequent use, but a withdrawal syndrome does not occur. Some volatile solvents may contain methanol (carburetor cleaning sprays); clinicians should identify the contents of the solvent whenever possible.
Symptoms and Signs of Volatile Solvent Use
Acute symptoms of dizziness, drowsiness, slurred speech, and unsteady gait occur early. Impulsiveness, excitement, and irritability may occur. As effects on the central nervous system increase, illusions, hallucinations, and delusions develop. Users experience a euphoric, dreamy high, culminating in a short period of sleep. Delirium with confusion, psychomotor clumsiness, emotional lability, and impaired thinking develop. The intoxicated state may last from minutes to > 1 hour.
Sudden death can result from respiratory arrest or airway occlusion due to central nervous system depression or arrhythmias ("sudden sniffing death," perhaps due to myocardial sensitization).
One chlorinated hydrocarbon, methylene chloride (dichloromethane), is metabolized to carbon monoxide and inhalation of this product can cause delayed onset of symptoms of carbon monoxide poisoning Carbon Monoxide Poisoning Carbon monoxide (CO) poisoning causes acute symptoms such as headache, nausea, weakness, angina, dyspnea, loss of consciousness, seizures, and coma. Neuropsychiatric symptoms may develop weeks... read more ; symptoms may persist for a prolonged period.
Methanol, a solvent that can be inhaled, may cause metabolic acidosis Metabolic Acidosis Metabolic acidosis is primary reduction in bicarbonate (HCO3−), typically with compensatory reduction in carbon dioxide partial pressure (Pco2); pH may be markedly low or slightly... read more and retinal injury.
Chronic inhalation of volatile hydrocarbons may irritate the skin around the mouth and nose (huffer's eczema).
Complications of chronic use may result from the effect of the solvent or from other toxic ingredients (eg, lead in gasoline). Carbon tetrachloride may cause a syndrome of hepatic and renal failure. Toluene may cause degeneration of central nervous system white matter, renal tubular acidosis Renal Tubular Acidosis Renal tubular acidosis (RTA) is acidosis and electrolyte disturbances due to impaired renal hydrogen ion excretion (type 1), impaired bicarbonate resorption (type 2), or abnormal aldosterone... read more , and hypokalemia Hypokalemia Hypokalemia is serum potassium concentration < 3.5 mEq/L (< 3.5 mmol/L) caused by a deficit in total body potassium stores or abnormal movement of potassium into cells. The most common... read more . Injuries to brain, peripheral nerves, liver, kidneys, and bone marrow may result from heavy exposure or hypersensitivity.
Inhalant abuse during pregnancy can cause premature birth and fetal solvent syndrome, which has features similar to those of fetal alcohol syndrome Fetal Alcohol Syndrome Alcohol exposure in utero increases the risk of spontaneous abortion, decreases birth weight, and can cause fetal alcohol syndrome, a constellation of variable physical and cognitive abnormalities... read more .
Diagnosis of Volatile Solvent Use
Usually a clinical diagnosis
Volatile solvents are not detected by routine drug screens. Many of them and their metabolites can be detected by gas chromatography at specialized laboratories, but such testing is rarely necessary or indicated except for forensic purposes.
Treatment of Volatile Solvent Use
Treatment for acute toxicity from volatile solvents is supportive. Use of catecholamines (eg, for hypotension) should be avoided because of possible solvent-induced myocardial sensitization. Treatment of arrhythmias is challenging and there is no specific treatment guideline. Beta blockers may have some benefit. Fomepizole may be used to treat inhalation and ingestion of methanol-containing solvents.
Treatment of solvent-dependent adolescents is difficult, and relapse is frequent. However, most users stop solvent use by the end of adolescence. Intensive attempts to broadly improve patients’ social skills and status in family, school, and society may help. For symptoms and treatment of poisoning with specific solvents, see table Symptoms and Treatment of Specific Poisons Symptoms and Treatment of Specific Poisons .
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Findtreatment.gov: Listing of licensed US providers of treatment for substance use disorders.
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