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Chapter: Modern Medical Toxicology: Substance Abuse: Substances of Dependence and Abuse

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Inhalants (“Glue Sniffing”,Volatile Substance Abuse, Inhalant-related Disorders)

Inhalant drugs (volatile substances) are widely available and frequently abused, especially by adolescents from poor socio-economic background.

Inhalants (“Glue Sniffing”,Volatile Substance Abuse, Inhalant-related Disorders)

Inhalant drugs (volatile substances) are widely available and frequently abused, especially by adolescents from poor socio-economic background. These substances are mostly volatile hydrocarbons which are used as solvents, propellants, thinners, and fuels (Table 34.16). The hydrocarbon is typically inhaled by pouring into a container for “sniffing”, a rag or sock for “huffing”, or a plastic/paper bag for “bagging”. Abusers often begin with “sniffing” (lower concentrations), and progress subsequently to “huffing” and “bagging” (higher levels of exposure).


The most commonly abused inhalants include toluene from paints and glues; petrol; butane from cigarette lighter fluids; butyl and isobutyl nitrite; and halogenated hydrocarbons from typewriter correction fluids, propellants, and dry cleaning fluids.

Inhalation of volatile substances produces intoxicating effects rapidly. They are well absorbed through the lungs and distributed quickly to the CNS. One or two huffs will begin to intoxicate the user within seconds, and the effects usually last for several hours. Chronic users can maintain a prolonged high with periodic inhalations every few hours.

Clinical (Toxic) Features

1. Acute

CNS—Excitation, agitation, hallucinations, headache,vertigo, nystagmus, ataxia, convulsions, lethargy, stupor, respiratory depression.

CVS—Arrhythmias and sudden death (“sudden sniffing death”).

Other Effects

–– Methaemoglobinaemia (butyl and isobutyl nitrites).

–– Carbon monoxide poisoning (methylene chloride).

–– Hepatitis (chlorinated hydrocarbons).

–– Metabolic acidosis, rhabdomyolysis, renal failure, hypokalaemia (toluene).

2. Chronic

Chronic painter syndrome—A neurobehaviouralsyndrome due to solvent-induced encephalopathy, char-acterised by memory loss, anxiety, depression, sleep disorders, neurasthenia, and personality changes. CT

·              scan often reveals areas of atrophy, and EEG readings are usually abnormal.

·              Cerebellar dysfunction with chorea (petrol).

·              Peripheral neuropathy (n-hexane).

·              Increased incidence of leukaemia, aplastic anaemia, and multiple myeloma (benzene).

·              Abdominal pain, nausea, vomiting, haematemesis.

·              Cardiomyopathy.

·              Hepatotoxicity.

·              Pulmonary disorders—pulmonary hypertension, acute respiratory distress.

·              Dementia (leaded petrol, toluene).

Treatment

Inhalant intoxication, like alcohol intoxication, usually requires no special treatment and resolves spontaneously. However, complications such as cardiac arrhythmias, bronchospasm, coma, etc. will require prompt treatment. Essentially, medical care primarily involves reassurance, quiet environment, and attention to vital signs and level of consciousness. Sedative drugs such as benzodiazepines are contraindicated, since they may aggravate intoxication. Severe agitation may require cautious control with haloperidol (5 mg for adults) intramus-cularly, repeated once after 20 minutes if necessary.

Inhalant dependence requires specialised treatment by a qualified psychiatrist, and may take 3 to 12 months for achieving total abstinence. Relapses are not uncommon.

Forensic Issues

Volatile substances abuse (VSA) is a uniquely adolescent phenomenon, and is particularly common among lower socioeconomic classes, mainly because these substances are cheap, easily available, and legal to possess. Also, the mode of intake is relatively simple. VSA is quite common among street urchins of major Indian cities, probably because these inexpensive substances offer a rare exciting experience to escape from the daily misery of poverty (Fig 34.21). Persons with adolescent conduct disorder and adult antisocial person-ality disorder are especially prone to VSA.




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