Inhalant abuse

Involves breathing in substances directly from its container or a rag soaked in a substance and inhaled over the nose and mouth, or breathing the fumes when the substance is in a plastic bag.

Nearly 20% of young persons experience inhalants at least once by the time they are in the eighth grade.

Mean age of first-time abuse is 13 years of age.

Utilize common household products.

Is a gateway phenomenon to use of other illicit drugs.

Substances include solvents, propellants, glues, adhesives, fuels and paint thinner.

Common chemicals abused include toluene, butane, propane, acetone, chlorinated hydrocarbons, and fluorocarbons.

Can induce euphoria.

If patients use a closed bag, rebreathing that occurs causes hypercarbia and hypoxia intensity the effects of the inhaled agent.

Patients present with nonspecific symptoms but may report dizziness, fatigue, irritability, anorexia, headache, photophobia and cough.

With long term abuse patients manifest neuropsychiatric sins and symptoms including memory loss, hallucinations, speech changes, impaired balance, visual changes, nystagmus, hearing and smell alterations and coma.

Acute complications of inhalant abuse include aspiration, accidental trauma, asphyxia, arrhythmias, hypoxia, vagal inhibition, respiratory depression and death.

As many as 50% of sudden deaths are related to sudden sniffing death syndrome in which the burst of catecholamines can trigger ventricular fibrillation.

Chronic use can cause toxicity to the brain, lungs, heart, kidneys, liver and bone marrow.

Myocardial injury includes myocarditis, fibrosis and congestive heart failure.

Can lead to renal toxicity with distal renal tubular acidosis, anion gap acidosis, renal failure, proteinuria, renal stones, Fanconi’s syndrome and hematuria.

Long term use can lead to bone marrow suppression and pancytopenia.

Neurologic toxicity most common chronic side effect of inhaled solvent abuse, with brain atrophy, widened cortical sulci, and MRI identified irreversible white matter changes.

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