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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.
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Management and Disposition
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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.
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Chronic abuse of nitrous oxide (N2O) may result ...