Acute lung injury.
Inhalants are volatile hydrocarbons that are used by huffing, bagging, and sniffing methods. Huffing refers to pouring the substance onto a rag then placing the rag over the mouth and inhaling. Bagging refers to placing the substance into a bag then breathing into the bag. This method places users at risk for hypoxia and subsequent respiratory failure. Unless the hydrocarbon is aspirated into the lungs, no direct pulmonary toxicity occurs. Sniffing is inhaling the vapors from a container such as rubber cement or glue. Sudden sniffing death has been reported since the 1960s. The typical scenario is an adolescent who has been abusing inhalants who is discovered by parents or police then experiences sudden cardiac arrest. Research suggests that hydrocarbons sensitize the myocardium to dysrhythmia by blocking the inward rectifier potassium channels and prolonging repolarization. The stimulus for dysrhythmias is a catecholamine surge that occurs in the setting of stress or surprise, which leads to ventricular fibrillation and death. The treatment of sudden sniffing death is electrical defibrillation with the addition of beta-blockade, which has been shown in several case reports to be beneficial.