Toluene Poisoning

Toluene Poisoning is a topic covered in the 5-Minute Emergency Consult.

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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 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

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

-- To view the remaining sections of this topic, please or --

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 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

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

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