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Clinical Summary

Inhalant abuse, the intentional inhalation of vapors for the purpose of becoming “high,” is more common among adolescents. Sniffing refers to the inhalation of the agent directly from a container, such as model airplane glue. Huffing involves placing solvent on some type of fabric and inhaling the vapors from the fabric. Bagging is the name given to the technique of spraying the solvent into a bag and then rebreathing from the bag. Occasionally the bag is placed over the head, potentially resulting in asphyxiant death. Inhalants are rapidly absorbed via the lungs and readily cross the blood-brain barrier. Initial effects include euphoria and occasional hallucinations. CNS depression may occur. Acute cardiotoxicity may also occur and is thought to be the cause of “sudden sniffing death.” The cause of death is thought to be due to increased myocardial sensitization that promotes dysrhythmogenesis in the setting of a catecholamine surge. A defatting dermatitis may be evident on the hands due to chronic exposure to solvents. Chronic effects from inhalant abuse include leukoencephalopathy, cardiomyopathy, cerebellar degeneration, and neuropathy.

Management and Disposition

Clues to the diagnosis of inhalant abuse are the presence of spray paint on the fingers or the face. Due to the increased solvent content in metallic-colored paints, gold and silver spray paint are particularly popular. Cardiac dysrhythmias are associated with a poor prognosis. Current recommendations suggest the use of β-blockers to treat ventricular dysrhythmias. Consider electrolyte abnormalities and acid-base status, particularly with toluene-based products. Benzodiazepines may be used for treatment of agitation.

FIGURE 17.48

“Huffing.” Patients who huff spray paints may present with the paint on their face and hands. (Photo contributor: Alan B. Storrow, MD.)

FIGURE 17.49

“Huffing.” The hand of the patient in Fig. 17.48. (Photo contributor: Alan B. Storrow, MD.)

FIGURE 17.50

“Bagging.” Silver paint lining is seen at the perioral area in a patient abusing the paint by “bagging.” (Photo contributor: R. Jason Thurman, MD.)

FIGURE 17.51

“Bagging.” Gold and silver metallic paints are particularly popular for inhalant abuse due to the increased solvent content in the paint and a greater “high.” (Photo contributor: R. Jason Thurman, MD.)

FIGURE 17.52

Motor Neuropathy of the Hand. The hands of a chronic huffer demonstrate the muscle wasting in the left hand in addition to a mild defatting dermatitis on the palm of the hand. (Photo contributor: Saralyn R. Williams, MD.)

Pearls

  1. Chronic abuse of nitrous oxide (N2O) may result ...

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