Clinical presentation and management in acute toluene intoxication: a case series

Abstract

Context: Toluene inhalation is a common form of drug abuse throughout the world. Acute toluene toxicity causes neurological changes as well as various metabolic alterations. Hypokalemic paralysis and renal failure are life-threatening complications.

Objective: To identify the clinical and metabolic alterations associated with toluene intoxication.

Materials and methods: We retrospectively analyzed the records of 22 patients that were admitted to a single center’s emergency department from 2006 to 2012 with clinical and metabolic alterations due to toluene inhalation.

Results: Of the 22 patients, 77% were male and mean age was 23.5 years (range: 17–30). The main clinical presentation was weakness associated to severe hypokalemia. Severe metabolic acidosis was found in 20 patients. Renal tubular acidosis was diagnosed in five patients. The patients responded to supportive measures and aggressive potassium repletion. Prognosis was generally good.

Conclusion: Toluene inhalation is associated with various severe metabolic alterations. Treatment guidelines are needed considering the frequency of toluene inhalation in the population.

Keywords::

• Toluene
• toxicity
• emergency department
• renal tubular acidosis
• hypokalemia