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Toluene Poisoning, Emergency Medicine

Michael E. Nelson Reviewed 06/2017
 


Basics

Description

  • Prototypical volatile hydrocarbon

  • Clear, colorless liquid with sweet odor

Etiology

  • Abused for its euphoric effect

  • Occupational exposures

  • Used as organic solvent found in:

    • Oil paints and st...

Diagnosis

Signs and Symptoms

  • Acute:

    • Neurologic:

      • Depression

      • Euphoria

      • Ataxia

      • Dizziness

      • Seizures

    • Cardiac:

      • Fatal dysrhythmias

    • Pulmonary:

      • Chemical pneumonitis

      • Pulmonary edema

    • Electrolytes:

      • Hypokalemia

      • Hypocalcemia

      • Hyperch...

Treatment

Pre-Hospital

  • Rapid onset of toxicity

  • Death possible with sudden cardiac dysrhythmias (sudden sniffing death), often from catecholamine surge (e.g., eluding police)

  • Topical decontamination as ne...

Follow-Up

Disposition

Admission Criteria

  • Altered mental status

  • Dysrhythmias

  • Hepatic dysfunction

  • Renal failure

  • Rhabdomyolysis

  • Severe metabolic derangements

  • Refractory hypokalemia

Discharge Criteria

After 4–6 hr ...

Pearls and Pitfalls

  • Myocardial sensitization to catecholamines:

    • Possibility of sudden dysrhythmia/death

    • Cardiac dysrhythmias have poor prognosis

  • Monitor and replete electrolyte abnormalities.

Additional Reading

  • Bowen  SE, Hannigan  JH. Developmental toxicity of prenatal exposure to toluene. AAPS J.  2006;8:E419–E424.

  • Filley  CM, Halliday  W, Kleinschmidt-Demasters  BK. The effects of t...

Codes

ICD9

  • 305.90 Other, mixed, or unspecified drug abuse, unspecified use

  • 982.0 Toxic effect of benzene and homologues

ICD10

  • F18.10 Inhalant abuse, uncomplicated

  • F18.120 Inhalant abuse with intoxication, ...

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