OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• Addiction medicine - drug and alcohol - main index and links
• drug dependency
• wikipedia

• Volatile substance abusers are typically young males although females increasingly involved, occurring esp. in poor socioeconomic areas, and fall into 4 main categories:
  • young adolescents (av. 12-13yrs) - many occasional or expt. users; (aka chroming / huffing)
  • polydrug users (typically mid-late adolescents);
  • inhalant-dependent adults who freq. abuse volatile substances exclusively & usually on a daily basis with more serious sequelae;
  • medical/dental/hospital/ambulance workers who abuse anaesthetic agents;
• In Aust., between 1980-87, there were 121 deaths associated with volatile substance abuse reported, averaging 16 per year, accounting for < 1% of all drug abuse-related deaths, but >50% occurred in 15-20yr old age group;
• Aetiologic agents in deaths from volatile agents in this period were:
  • 27% fuel gases; 25% solvents; 24% aerosols; 14% petrol; 10% anaesthetics;

• anoxia;
• resp. depression;
• vagal inhibition - esp. with aerosols (freon) sprayed directly into mouth;
• bronchospasm - esp. freon;
• cardiac arrhythmias - hypoxia + volatile drug sens. myocard. to adrenaline; - esp. freon;
• burns - esp. petrol;

• Includes alcohols, esters, ketones, aliphatic & aromatic hydrocarbons & halogenated hydrocarbons inhaled directly from container, on rag, or placed in plastic bag;
• Concentrations achieved may exceed industrial “safe” levels by many 1000-fold!!
• Commonly abused:
  • adhesives, plastic cement & thinners (toluene/xylene), cleaning agents, typist correction fluid & thinners (trichloroethane & trichloroethylene);
  • fluorocarbon propellants (freons) used in aerosols & as refridgerants;
  • bromochlorodifluomethane (BCF) used in fire extinguishers;
• Most are CNS depressants & early effects resemble alcohol intoxication & inhalation allows rapid onset & relatively short duration of effect;
• Continued inhalation:
  • → confusion, perceptual distortion, hallucinations → aggression often
• Higher doses:
  • → ataxia, dysarthria, convulsions, & coma may ensue;
  • → acute cardiotoxicity - esp. toluene;
• Chronic abuse:
  • → perioral rash if use breathing from plastic bag method;
  • → renal tubular acidosis often irreversible - esp. toluene
  • → encephalopathy often irreversible - esp. toluene;
  • → metab. acidosis - esp. toluene;
  • → cerebellar dysfunction - esp. toluene;
  • → pulm. hypertension / cor pulmonale /cardiomyopathy - esp. toluene;
  • → periph. neuropathy - esp. n-hexane;
  • → hepatic necrosis, nephropathy, neuropathy, myocard. damage - esp. trichloroethane & trichloroethylene;

• Petrol sniffing particularly a problem in societies that may be seen as poor & powerless:
  • Aust. Aborigines, black Sth Africans, American Indians;
• Petrol consists of C4 to C12 hydrocarbons - the unsaturated ones having mild anaesthetic properties, whilst the saturated ones have a narcotic effect. In addition, the principal additive, tetraethyl lead & its metabolites are highly neurotoxic → lead poisoning;
• 15-20 inhalations of petrol causes euphoria & intoxication for 3-6hrs;
• Prolonged inhalation or rapid inhalation such as petrol-soaked cloth held over nose, may lead to violent excitement followed by LOC, coma, cardiac arrhythmias or death;
• Chronic sniffing produces long-term sequelae mainly due to tetraethyl lead but may also be due to toluene or n-hexane if these are present:
  • ataxia, tremor, encephalopathy, nutritional disturbances, anaemia, cardiac, liver & renal effects, impaired cognitive functioning;