Volatile Substances of Abuse

Clinical and biochemical analysis of acute paint thinner intoxication in adults: a retrospective descriptive study

CONTEXT

Paint thinner contains a mixture of various aromatic hydrocarbons. A few studies have reported biochemical abnormalities and clinical symptoms of paint thinner intoxication among adult patients.

OBJECTIVE

We aimed to design a retrospective descriptive study to evaluate clinical and laboratory biochemistry abnormalities due to paint thinner intoxication among adult patients.

METHODS

Data were obtained by using questionnaires from paint thinner-intoxicated patients recruited at the Loghman-Hakim General Teaching Hospital Poison Center.

RESULTS

Clinical and paraclinical data from a total of 37 patients, 24 males (64.86%) and 13 females (35.14%) with the mean age of 34.35 ± 14.15 years and mode of 22 years, was obtained and analyzed. Patients' ages ranged between 15 and 70 years. The estimated mean consumed dose was 246.70 ± 390.72 ml with a mode of 60 ml (range of 1-1500 ml). Nausea, vomiting, asthma, sore throat, stomach ache, drowsiness, dizziness, agitation, cough and diarrhea were the most frequent clinical features, respectively. Reported tissue damage biomarkers were alkaline phosphatase (ALP, 233.84 ± 122.06) and lactate dehydrogenase enzymes (LDH, 749.33 ± 471.03 IU/l). They reflected development of liver and pulmonary toxicities. Arterial blood gas (ABG) showed acidosis without hypoxia in adult paint thinner-intoxicated patients.

DISCUSSION AND CONCLUSION

Focusing on biochemical abnormalities and clinical toxicity symptoms is essential for screening organs in paint thinner toxicity. In addition, they provide good information for physicians/clinical toxicologists to perform appropriate conservative treatments in adult paint thinner-intoxicated patients.

Glue Sniffing: A Review

Inhalant abuse is a prevalent and often overlooked form of substance abuse in adolescents and young adults. It causes a euphoric feeling, may become addictive and can be a serious health concern associated with significant morbidity and mortality. Acute effects of inhalants include sudden sniffing death syndrome, asphyxia, and traumatic injuries. Chronic inhalant abuse can damage the brain, heart, lung, kidney, liver, and bone marrow in addition to being an important cause of psychosocial and economic problems. This article is proposed to emphasize on the harmful effects of glue-sniffing, its prevention and management.

Recanting of life-time inhalant use: how big a problem and what to make of it

AIMS

To establish the prevalence of recanting of life-time inhalant use, identify correlates of recanting to gain insight to its causes and develop a method for distinguishing recanters who truly are versus are not life-time users of inhalants.

DESIGN AND SETTING

Longitudinal survey data from students in 62 South Dakota middle schools who were participating in a field trial to evaluate a school-based drug prevention program.

MEASUREMENTS

At grades 7-8, participants reported on their life-time inhalant use, other drug use and drug-related beliefs, attitudes and behaviors.

FINDINGS

Forty-nine per cent of students who reported life-time inhalant use at grade 7 recanted their reports a year later. Comparison of students who recanted inhalant use with those who did or did not report inhalant use consistently on drug-related beliefs, attitudes and behaviors at grades 7 and 8 suggested that, whereas some inhalant use recanting reflects denial of past behavior, some reflects erroneous initial reporting. Based on a latent mixture model fitted to the multivariate distribution of grade 7 and grade 8 responses of recanters and consistent reporters, we calculated the probability that each recanter was, in fact, a life-time inhalant user. An estimated 67% of the recanters in our sample appear to be life-time inhalant users who admitted use in grade 7 and then denied that use at grade 8; 33% appear to be students who reported use incorrectly at grade 7 and then corrected that error at grade 8.

CONCLUSIONS

Inhalant use recanting is a significant problem that, if not handled carefully, is likely to have a considerable impact on our understanding of the etiology of inhalant use and efforts to prevent it.

Early and late complications among 15 victims exposed to indoor fire and smoke inhalation

AIM

To evaluate early and late complications among victims exposed to indoor fire and smoke inhalation.

METHOD

An observational, descriptive and prospective longitudinal study of 15 victims of smoke inhalation admitted to the intensive care unit.

RESULTS

Although without significant burns, 13 of the victims were unconscious, with airway injury, abnormal temperature and hypokalaemia, and underwent mechanical ventilation. Initial carbon monoxide concentration averaged 20.4+/-8.3%, dropping to 3.9+/-3.3% 4h later. On the 1st day, two victims recovered and were transferred, and another two died. Creatine kinase levels (2594+/-2455 U/l) correlated with duration of intensive care. Of the remaining 11 patients, 10 had early pneumonia. Steroid treatment was initiated for four patients receiving prolonged mechanical ventilation, because of persistent fever and dry cough without evidence of infection.

CONCLUSIONS

Mortality and systemic involvement were related to burn of the upper airway and contact with combustion products. Initial creatine kinase levels emerged as a prognostic marker of injury severity. Bronchoscopy was useful in grading airway injury and obtaining bronchoalveolar culture. Corticosteroids were effective, after the acute phase, in treating non-infectious pulmonary complications.

Psychiatry in orthodontics. Part 2: Substance abuse among adolescents and its relevance to orthodontic practice

Substance abuse by adolescents is a serious problem that will touch every orthodontic practice. Recent data show that 40% of tenth graders in the United States will use an illicit drug at some time, and 18% will do so in a 30-day period. These are significant figures that should impact orthodontic diagnosis and treatment planning. The nature of orthodontic treatment is unique in that the orthodontist will see relatively healthy adolescent patients on a monthly basis over a period of years. The orthodontist is in a prime position to recognize potential substance abuse problems and make referrals. This article discusses various types of substance abuse, diagnosis, options for referral, and orthodontic implications.

Concealed mothball abuse prior to anesthesia: mothballs, inhalants, and their management

Mothballs are one of a number of volatile compounds including model airplane glue, spray paint, nail polish remover, room fresheners, and gasoline that are intentionally inhaled for the purpose of recreational self-intoxication. Their inhalation produces a rapid 'high' characterized by euphoria and generalized intoxication. Chronic abuse can be associated with significant organ impairment, and, in rare cases, cardiac dysrhythmias and deranged end-tidal gas monitoring. Mothballs contain the aromatic compound naphthalene and/or paradichlorobenzene. Prolonged exposure can cause hepatic failure and severe hemolytic anemia. We present a case of a young adult who initially concealed her chronic mothball inhalation. The literature regarding mothball abuse as well as inhalant abuse relevant to anesthesia is reviewed, and suggestions for the diagnosis and peri-operative management are offered.

Acute respiratory failure from abused substances

Acute respiratory failure is a common complication of drug abuse. It is more likely to develop in the setting of chronic lung disease or debility in those with limited respiratory reserve. Drugs may acutely precipitate respiratory failure by compromising respiratory pump function and/or by causing pulmonary pathology. Polysubstance overdoses are common, and clinicians should anticipate complications related to multiple drugs. Impairment of respiratory pump function may develop from central nervous system (CNS) depression (suppression of the medulla oblongata, stroke or seizures) or respiratory muscle fatigue (increased respiratory workload, metabolic acidosis). Drug-related respiratory pathology may result from parenchymal (aspiration-related events, pulmonary edema, hemorrhage, pneumothorax, infectious and non-infectious pneumonitides), airway (bronchospasm and hemorrhage), or pulmonary vascular insults (endovascular infections, hemorrhage, and vasoconstrictive events). Alcohol, cocaine, amphetamines, opiates, and benzodiazepines are the most commonly abused drugs that may induce events leading to acute respiratory failure. While decontamination and aggressive supportive measures are indicated, specific therapies to correct seizures, metabolic acidosis, pneumothorax, infections, bronchospasm, and agitation should be considered. Drug-related respiratory failure when due to CNS depression alone may portend well, but in patients with drug-related significant pulmonary pathology, a protracted course of illness may be anticipated.

Inhalant abuse in the pediatric population: a persistent challenge

Inhalants remain one of the most commonly abused substances by adolescents in the United States today. Recent epidemiologic studies have demonstrated a decrease in the prevalence of inhalant abuse, but overall rates remain high. Inhalants have the potential to result in serious organ system dysfunction or even sudden death. This article reviews the most recent epidemiologic data on inhalant abuse, summarizes the types of substances used and their mechanism of actions, and discusses clinical toxicity and medical management.

Characterization of glomerular cell phenotypes following repeated cycles of benzo[a]pyrene injury in vitro

Exposure of cultured glomeruli to benzo[a]pyrene (BaP), a carcinogenic hydrocarbon, modulates mesangial and visceral epithelial cell proliferation in vivo and in vitro. The present studies were conducted to characterize mitogenic signaling profiles of cultured glomeruli following repeated cycles of BaP challenge. Enhanced rates of DNA synthesis were observed by the third passage in randomly cycling cultures after single or repeated carcinogen exposure. This response was characterized by upregulation of mitogenic sensitivity during early cell cycle transit, and increased cell numbers under restrictive growth conditions. The mitogenic response to platelet-derived growth factor (0.5 to 25 ng/mL), acidic fibroblast growth factor (2.5 to 10 ng/mL), basic fibroblast growth factor (0.05 to 5 ng/mL), epidermal growth factor (0.5 to 5 ng/mL), or conditioned medium was not enhanced by hydrocarbon challenge. BaP-treated cultures exhibited anchorage-independent growth and increased expression of hepatocyte growth factor mRNA and E-cadherin protein. Binding of activator protein-1 to DNA was enhanced in BaP-treated cells, but this change did not involve truncation or mutation of the c-jun delta region. Collectively, the data demonstrate that repeated cycles of BaP injury alter mitogenic signaling profiles in cultured glomerular cells. These alterations may contribute to deregulation of proliferative control following carcinogen exposure in vivo.

Inhalant abuse by adolescents

The deliberate misuse of volatile substances poses a poorly recognized risk for considerable morbidity and mortality in adolescent populations worldwide. The abuse of inhalants continues to be a significant problem among our country's youth. While many household and industrial chemicals can be inhaled, glues, paints, and aerosol propellants are among the most commonly abused. Adolescents are often unaware of the health threats posed by inhalation of solvents. Inhalation can result in serious organ system dysfunction or even sudden death. This review discusses the prevalence of inhalant abuse in the United States, summarizes the various types of substances used, highlights the major physiologic effects of inhalants, and briefly discusses associated risk behaviors, prevention and medical management.

Abuse of inhalants: a review

Inhalants, a chemically heterogeneous group of psychoactive substances found in adhesives, lighter fluids, spray paints, cleaning fluids and typewriter correction fluid, may be used by up to 10% of young people. This article reviews the health effects, epidemiology, risk of other substance use and addiction and psychiatric co-morbidity associated with the practice of inhalant use.