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The authors discuss the clinical approach to the management of hydrocarbon ingestions, including the role, implementation, and type of gastric decontamination utilized; the extent of medical evaluation, observation or hospitalization required; and the appropriate therapy for hydrocarbon pneumonitis. An appendix covers myocardial sensitization following inhalation abuse of hydrocarbons.
While many organic solvents are, in large doses, capable of inducing an acute, reversible narcotic state, few unequivocally induce chronic, long-lasting, or irreversible changes in nervous system structure and/or function. For organic solvents with proved neurotoxic properties, the type of neurological damage is closely related to the structure of the chemical agent, while the degree of impairment and the extent of reversibility are related to the potency, dose, and duration of exposure. Examples include solvents containing n-hexane or methyl n-butyl ketone, which have caused many cases of occupational neuropathy. Chronic inhalation abuse of pure toluene produces irreversible cerebellar, brainstem, and pyramidal-tract dysfunction, but comparable changes have not been found in solvent workers occupationally exposed to toluene. Ototoxicity is found in experimental animals exposed to toluene, xylene, or styrene. Impure trichloroethylene has a predilection for damaging the trigeminal nerve; dichloroacetylene, a breakdown product of trichloroethylene, is probably responsible for this neurotoxic property. Prolonged occupational exposure to mixed solvents, notably white spirit, has been reported to induce a mild, nonprogressive dementing illness with or without peripheral nerve dysfunction, but supporting data from neuropathological and experimental animal studies are lacking. Many other solvents have been reported to induce adverse effects in workers. The pivotal biological role of the nervous system and its vulnerability to selected organic solvents widely used in industry underline the urgent need for further clinical and experimental research on this problem.
Inhalation abuse of various toxic agents continues to be a significant health problem among the younger segment of our society. We describe four cases of sudden death in adolescents associated with recreational sniffing of typewriter correction fluid occurring during the period 1979 through mid-1984. The solvents used in most of these fluids, 1,1,1-trichloroethane and trichloroethylene, are known to induce potentially fatal arrhythmias. Sniffing typewriter correction fluid poses a significant and underappreciated danger to the lives of these abusers. School health officials, public health departments, and law enforcement personnel should be alerted to the need for surveillance of this type of activity.
In a study on the neurotoxicity of abused inhalants, male Fischer rats were exposed by inhalation to several concentrations of hexane, administered continuously or intermittently. The fifth component of the brainstem auditory-evoked response (BAER) increased in latency and decreased in amplitude in rats exposed to 1,000 ppm of hexane 24 hours per day, 5 days per week, for 11 weeks. The first component of the BAER was only slightly affected, indicating that the increased latency of the fifth component reflected a brainstem dysfunction. Latency returned to normal within 5 weeks after termination of exposures, but amplitude did not. Latency of the compound action potential of the ventral caudal nerve of the tail of these rats was also increased, and this effect was still present 22 weeks after termination of the exposure. Other rats were not as severely affected by repeated, brief (10 minutes) exposures to 24,000 or 48,000 ppm hexane 6 or 12 times per day; only the amplitude of the fifth BAER component was affected by the 48,000-ppm exposure.
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Plasma and erythrocyte levels of selenium (Se) and zinc (Zn) have not been investigated in volatile (inhalant) substance abusers previously, although changes in the activities of antioxidant enzymes resulting from oxidative damage caused by various constituents of volatile substances have been shown in a few animal and human studies. Concentrations of these two elements in erythrocytes and plasma of 37 adolescents with inhalant abuse were measured by atomic absorption spectrophotometry and compared with those of 37 age-matched healthy controls. Erythrocyte and plasma levels of Se and plasma level of Zn were significantly lower in the study group when compared to the control group. Chronic inhalation of volatile substances can decrease the plasma levels of Se and Zn and, thus, may lead to a decrease in the activity of antioxidant enzyme systems in adolescent abusers. The role of Se and Zn supplementation in children with inhalant abuse remains to be determined considering the reduced antioxidant activity resulting from deficiency of these trace elements.
When children wheeze Would no one please provide their medicine blindly: for this might ease their young demise and that would be unkindly. Excessive use of salbutamol inhalers is described in two young people with asthma, a girl and a boy both aged 15 years. These cases and others quoted indicate that dependence on pressurized aerosol bronchodilators can and does occur in young people. Known side-effects of salbutamol are described. Where over-usage occurs a state of diminished airways response seems to result: it is also possible that the convulsions which occurred in one case may be related to such abuse. Responsibility for the provision and use of these inhalers in young people is discussed and suggestions made towards their greater control.
During a school-based survey, middle and high school students (n = 1536) reported on their nonprescribed, lifetime use of asthma inhalers. Approximately 15% of 8th and 9th graders reported using nonprescribed asthma inhalers; the odds for this behavior were significantly higher for these students (2.25 and 2.30, respectively) and the nonprescribed use of asthma inhalers was significantly associated with higher rates of other drug use.
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Explore the source record for details and available documents.
Patterns of lipid peroxidation and the state of antioxidant systems were studied in 30 healthy volunteers (control), 18 patients with toxicomania developed as a result of inspiration of organic solvent vapors, 21 patients with chronic alcoholism and in 27 patients with opium narcomania within 4-6 years after withdrawal. The data obtained suggest that activation of lipid peroxidation and decrease in the rate of antioxidant response, which were detected in the patients with narcomania, correlated with severity of the psychopathological failures induced by chronic toxic effect of the narcotics or toxic preparations applied.
The study was carried out 11 boys, 12-17 years old, treated in the Therapeutic-Educational Guidance Center for the Young because of using inhalant stupefacients and incliniation to alcohol abuse. The inhalant stupefacients were taken for a period of 6 months to three years, of alcohol--from 6 months to 2 years. The most common inhalant stupefacients were "Butapren" glue, trichlorethylene and "Roxy" fluid; wine and vodka were the alcohols used. No one patient displayed the full dependence syndrome, most of them (83%) had organic CNS damage, in 63% pathological EEG changes were recorded. The alcohol inebriation was accompanied by marked psychomotor excitation with cognitive disturbances, aggressiveness, anxiety, self-mutilation. One patient developed visual illusions and hallucinations. The findings suggest that the consequences of abuse of inhalant stupefacients significantly influence the syndrome of alcohol intoxication, potentiating the psychopathological signs.
PURPOSE: To assess the relationship between prescription asthma inhaler misuse and other substance abuse. METHODS: The study included a random sample of 5th through 10th grade students attending one, ethnically diverse school district in metropolitan Detroit (N=1017). A cross-sectional, web-based survey design was used. The survey included questions about the use and misuse of prescribed asthma inhalers (among other medications) as well as the use of alcohol, cigarettes, marijuana, and other drugs. We investigated four types of interaction with prescribed asthma inhalers: non-use, prescribed use, prescribed use and misuse, and misuse. RESULTS: Students who misused asthma inhaler medication during their lifetimes were more likely to smoke cigarettes and marijuana as well as more likely to drink alcohol, binge drink and have used other illicit drugs. Students who used asthma inhaler medication solely as prescribed were no more likely to abuse drugs or alcohol than non-users of prescription asthma inhalers. CONCLUSIONS: Our findings are of interest to clinicians who provide health care to adolescents. The present study also has implications for adults managing prescription asthma medication in households and schools.
A case of albuterol abuse by a pediatric patient with the development of hypokalemia with electrocardiographic changes is presented. The hypokalemic effects of beta2-agonists are discussed in regard to the production of significant cardiac symptoms. Additionally, guidance regarding the evaluation of similar patients presenting in the emergency department is provided.
Mothballs are one of a number of volatile compounds including model airplane glue, spray paint, nail polish remover, room fresheners, and gasoline that are intentionally inhaled for the purpose of recreational self-intoxication. Their inhalation produces a rapid 'high' characterized by euphoria and generalized intoxication. Chronic abuse can be associated with significant organ impairment, and, in rare cases, cardiac dysrhythmias and deranged end-tidal gas monitoring. Mothballs contain the aromatic compound naphthalene and/or paradichlorobenzene. Prolonged exposure can cause hepatic failure and severe hemolytic anemia. We present a case of a young adult who initially concealed her chronic mothball inhalation. The literature regarding mothball abuse as well as inhalant abuse relevant to anesthesia is reviewed, and suggestions for the diagnosis and peri-operative management are offered.
1 A wide range of compounds which may be abused by inhalation such as butane, the halons, 1,1,1-trichloroethane, trichloroethylene and toluene can be detected and identified in blood specimens by means of headspace gas chromatography. Quantitative analysis of a number of the less volatile compounds of interest may also be accomplished. 2 The measurement of the urinary concentrations of benzoic and hippuric acids (metabolites of toluene) and of the toluric acids (metabolites of the xylenes) by high performance liquid chromatography may provide useful information. In general, a hippurate/creatinine ratio of greater than 1 is indicative of recent toluene exposure. 3 Analysis of the product abused by vapor-phase infra-red spectrophotometry and/or gas chromatography may also be valuable, especially since manufacturers' data as to the constituents of a given product are not always accurate. 4 Toxicological analyses can provide clinically valuable diagnostic information where inhalational abuse of volatile substances is suspected, and provide the only unequivocal means of defining the agent(s) abused by a given population.
Although acute and chronic toxic effects of inhalant (glue) abuse have been well demonstrated on many organ systems, the effects on the skeletal system and bone mineral content of young people with this addiction have, to our knowledge, not yet been investigated by bone mineral density measurement. In the present study bone mineral density was measured by the dual-energy X-ray absorptiometry method in 25 children and adolescents with inhalant abuse and compared with that of a control group (n=30) to detect whether there was any delay in bone development or any decrease in bone mass. Chronological age, height and weight, serum calcium, phosphorus and alkaline phosphatase levels of the study group were not significantly different from those of the control group (p>0.05), whereas bone mineral density was significantly reduced in the study group (p=0.001). Teenagers with glue vapor abuse may carry an increased risk of future fracture even though the exact mechanism(s) responsible for the toxicitiy of glue vapor on bone metabolism remains to be determined. To ascertain the exact component of glue responsible for bone demineralisation may be of value in proposing a change in the composition of the glue. Education and/or rehabilitation programs currently have the greatest importance in preventing and overcoming the harmful effects of this public health problem which is so common in young children and adolescents.