What Are the Complications of Inhalant Abuse?

Patient Presentation
A 10-year-old male was brought to the Emergency Department because of being unarousable. His 16-year-old sister found him in his bedroom, and couldn’t really arouse him and she called emergency services. Emergency services said that he became more alert during the transport. They described the residence as very messy and unhygienic. In his room they found several cans of various aerosols and e-cigarettes in a bag next to him. There were no adults at home so they also transported the 16-year-old and two other children. The past medical history given by the older sister said he was healthy and there were no significant family history. She denied any substance abuse in the household but said there were other apartments in the building that did.

The pertinent physical exam showed the vital signs were normal except for a heart rate range between 120-140. His respiratory rate was 20 without distress. He had some blue marks on his face, irritated eyes and rhinorrhea. His lungs were clear. His heart was tachycardic without murmurs. Abdomen and extremities were normal. He was awake with normal mentation in the ER but if left alone would want to sleep.

The work-up showed mildly elevated transaminases, but normal electrolytes, BUN, creatinine and urinalysis. Electrocardiogram showed sinus tachycardia. His creatinine kinase was normal. Toxicology eventually was normal. The patient’s clinical course showed he was admitted to the hospital for IV fluids, monitoring and further evaluation. During his hospitalization he said he had been trying various inhalants for a few weeks. He would do this usually late at night. He had tried e-cigarettes and beer as well but denied any other drugs. He and the other children were placed with a family member who lived close to the parents’ home while the Department of Human Services investigated. The Department offered a variety of services under the “child in need of services” pathway which included counseling for the children and parents. Longer term followup was not known.

Discussion
Hydrocarbons (HC) are organic compounds that are abused because they produce a euphoric effect, usually quickly, are low cost and easily obtained. They are commonly abused by adolescents and use in the US is either stable or increasing.

Volatile HC rapidly distribute throughout the body which produces euphoria in seconds to minutes. There are 3 ways that HC are inhaled:

• Sniffing – directly inhaling the HC from the container. This has the lowest HC concentration.
• Huffing – a cloth is saturated with the HC and then the cloth is held to the nose and mouth and inhaled. This has a higher concentration than sniffing and lower than bagging.
• Bagging – the HC is sprayed into an impermeable bag and then the bag is placed over the nose and mouth and inhaled, or the bag is placed over the entire head and inhaled. This has the highest HC concentration.

Common HC that are abused include:

• Aliphatic (straight chain) – butane, gasoline, propane
• Alkyl halides – aerosol cans, freon, paint strippers
• Aromatic (cyclic) – adhesive, benzene, glues, spray paint, toluene, varnishes
• Nitrites – air fresheners
• Ethers/Ketones – adhesive, nail polish remover, paint

Ways to identify potential inhalant abuse includes stains of the substance used (i.e. paint), rashes around the mouth and/or nose, and signs of irritation of the mucous membranes of the head including conjunctivitis, sneezing, rhinitis, epistaxis, and sore throat. The lung is the most commonly affected organ.

Learning Point
Complications with hydrocarbon inhalants includes: