Toluene Poisoning

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 stains
  • Paint thinners
  • Glues, inks, dyes, correction fluid
  • Coolants
  • Petroleum products
  • Aerosolized household products
  • Degreasers
• Production and use of gasoline is the largest source of exposure

Pathophysiology

• Mechanism:
  • Rapidly absorbed by inhalation
  • Readily crosses blood–brain barrier, reaching high concentrations in brain
  • Inhibits NMDA receptors, increase GABA and glycine receptor function
  • Induces oxygen radicals in the brain, particularly the hippocampus (learning and memory)
  • May sensitize myocardium to arrhythmogenic effect of catecholamines
  • Inhibits myocardial voltage-gated sodium channels and inward rectifying potassium channels
  • Alveolar excretion and liver metabolism
• Methods of intoxication:
  • Sniffing: Simple inhalation of substance directly from container
  • Huffing: Vapors inhaled through cloth saturated with substance
  • Bagging: Vapors inhaled from bag containing substance
• Toxic range:
  • 100 ppm: Impairment of psychomotor and perceptual performance
  • 500–800 ppm: Headache, drowsiness, nausea, weakness, and confusion, potential lethal ranges
  • >800 ppm: Convulsions, ataxia, staggering gait
  • 10,000–30,000 ppm: Anesthesia within 1 min

• Prevalent in adolescent age group:
  • Inexpensive “high” with readily available sources
  • Many psychosocial problems