Abstract
BackgroundToluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication.MethodsWe prospectively assessed 20 patients that were admitted to a single center’s emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication.ResultsThe main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80 % of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities.ConclusionThe hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.
Highlights
Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression
In a previous case series, we retrospectively studied 22 cases of acute toluene toxicity and found that toluene inhalation is associated with various severe metabolic
We described elevations in alkaline phosphatase (ALP), and in a few patients, instances of rhabdomyolysis and proteinuria, but our data were insufficient to determine the relevance of these findings due to incomplete work-ups
Summary
Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. Dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. Toluene is present in many industrial solvents, and is responsible for environmental, accidental as well as intentional intoxications. It is the most widely abused inhaled volatile drug. No deaths were reported in that case series In this prospective study, we sought to examine these alterations more thoroughly, to examine possible risk factors for poor outcome and the prognosis
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