Edit concept Question Editor Create issue ticket

Toluene Poisoning

Poisoning by Toluene

Toluene poisoning principally occurs through inhalation, either by intentional abuse or accidentally in the industrial setting, given its widespread use in the synthesis of organic solvents. Symptoms arise due to severe hypokalemia and metabolic acidosis, most prominent being weakness and paralysis, as well as neurological deficits and gastrointestinal irritation. Confirming exposure to toluene during history taking is crucial to make the diagnosis.


Presentation

Toluene is an aromatic hydrocarbon used in the production of industrial solvents that are present in paints and various chemical substances, including pharmaceutical and sanitation products [1] [2]. Thus, many occupations carry an increased risk for accidental exposure to higher concentrations of this compound. Toluene poisoning, however, is much more commonly encountered in individuals who intentionally abuse toluene through "glue sniffing", described as the second most common type of teenage substance abuse [2] [3] [4]. As a result, adolescents are the main patient group [3]. Signs and symptoms appear due to the extensive production of hydrogen ions during its metabolic degradation in the liver, leading to two major pathological mechanisms responsible for symptom appearance - severe metabolic acidosis and hypokalemia [2] [3] [4]. Furthermore, toluene can deposit in adipose tissues, implying that its metabolism requires a significant amount of time after being introduced into the human body [3]. Consequently, both acute and chronic forms of poisoning might be recognized. In the acute setting, euphoria, disinhibition, and tinnitus are prominent features [3]. Conversely, profound muscle weakness (or even paralysis) is the main symptom of chronic toluene poisoning, accompanied by gastrointestinal complaints (abdominal pain, nausea, vomiting and hematemesis) and central nervous system (CNS) abnormalities - altered mental status, confusion, hallucinations, euphoria, depression, ataxia and visual deficits [2] [5]. Fatigue, but also cardiac arrhythmias are reported by certain authors [3] [5]. In severe cases, renal failure (developing on the grounds of rhabdomyolysis and marked acidosis) and acute respiratory distress syndrome (ARDS) may occur [2].

Anemia
  • Action of pure TNT and of impurities Action of TNT in the system and the connection of minor TNT illness toxic jaundice and aplastic anemia Action of TNT on the blood Aplastic anemia causing TNT poisoning Cases skewing intimate relation between cyanosis[momicoh.pastperfectonline.com]
  • Hematologic consequences of exposure may include: lymphocytosis, macrocytosis, eosinophilia, hypochromia, and basophilic stippling, and in severe cases, aplastic anemia.[getwellstaywellathome.com]
Gastric Lavage
  • lavage ) Surgery to remove burned skin Breathing support, including tube through the mouth into the lungs and breathing machine (ventilator) How well someone does depends on how severe the poisoning is and how quickly treatment is received.[medlineplus.gov]
  • Gastric lavage (“stomach pumping”) for patients who have ingested toluene-containing substances. Irrigation (“washing out”) of the skin at points of contact with toluene-containing substances.[healthhype.com]
Painful Cough
  • Cough Rapid, shallow breathing NERVOUS SYSTEM Convulsions Dizziness Drowsiness Extreme feeling of well-being (euphoria) Headache Memory loss Nervousness Staggering Tremors Unconsciousness SKIN Dry, cracked skin Pale skin Get medical help right away.[medlineplus.gov]
Nausea
  • Conversely, profound muscle weakness (or even paralysis) is the main symptom of chronic toluene poisoning, accompanied by gastrointestinal complaints (abdominal pain, nausea, vomiting and hematemesis) and central nervous system (CNS) abnormalities - altered[symptoma.com]
  • Those who have pursued toluene poisoning claims have often complained of headaches, nausea and lack of coordination as initial symptoms. When there has been an extreme amount of vapours inhaled poisoning can lead to unconsciousness or death.[jefferies-solicitors.com]
  • EYES, EARS, NOSE, AND THROAT Blurred vision Burning pain Hearing loss STOMACH AND INTESTINES Bloody stools Abdominal pain (severe) Loss of appetite Nausea Vomiting (may be bloody) HEART AND BLOOD VESSELS Irregular heartbeat Low blood pressure KIDNEYS[medlineplus.gov]
  • Gastrointestinal symptoms from inhalation and ingestion may result in abdominal pain, nausea, vomiting, and hematemesis. Hepatotoxicity manifests with ascites, jaundice, hepatomegaly, and liver failure.[getwellstaywellathome.com]
  • The smell of solvent and the nausea got away relatively quickly. Finally, the forth day, afraid of having some sort of irreversible damage, I was concerned for the first half of the day.[drugs-forum.com]
Vomiting
  • Conversely, profound muscle weakness (or even paralysis) is the main symptom of chronic toluene poisoning, accompanied by gastrointestinal complaints (abdominal pain, nausea, vomiting and hematemesis) and central nervous system (CNS) abnormalities - altered[symptoma.com]
  • These include vomiting, convulsions, or a decreased level of alertness. If the person breathed in fumes, move them to fresh air right away.[medlineplus.gov]
  • Gastrointestinal symptoms from inhalation and ingestion may result in abdominal pain, nausea, vomiting, and hematemesis. Hepatotoxicity manifests with ascites, jaundice, hepatomegaly, and liver failure.[getwellstaywellathome.com]
  • Symptoms and Signs After ingestion of even a very small amount of liquid hydrocarbon, patients initially cough, choke, and may vomit. Young children may have cyanosis, hold their breath, and cough persistently.[merckmanuals.com]
  • […] organ and system specific signs of toluene exposure includes : Headaches Dizziness Confusion Difficulty concentrating Hallucinations Memory loss Red eyes Burning sensation in the mouth, eyes and throat Difficulty breathing Chest pain Wheezing Nausea Vomiting[healthhype.com]
Chest Pain
  • pain Cough Rapid, shallow breathing NERVOUS SYSTEM Convulsions Dizziness Drowsiness Extreme feeling of well-being (euphoria) Headache Memory loss Nervousness Staggering Tremors Unconsciousness SKIN Dry, cracked skin Pale skin Get medical help right away[medlineplus.gov]
  • There was no history of fever, cough, dyspnea, or chest pain prior to this episode. Patient had tachycardia, hypotension, tachypnea, agitated behavior, and coarse crepitations all over chest.[mjdrdypu.org]
  • pain Wheezing Nausea Vomiting Jaundice Abdominal pain Muscle weakness Muscle pain Glue Sniffer’s Rash Many of the symptoms of acute and chronic toluene exposure can be attributed to various other, and more common, diseases.[healthhype.com]
Purpura
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Flushing
  • If the substance is on the skin or in the eyes, flush with lots of water for at least 15 minutes. If the person swallowed the substance, give them water or milk right away, if a provider tells you to do so.[medlineplus.gov]

Workup

The diagnosis of toluene poisoning rests on the ability of the physician to recognize signs and symptoms and confirm exposure to this aromatic hydrocarbon. For this reason, a properly obtained patient history (often requiring hetero-anamnestic data) and a detailed physical examination are perhaps essential steps during the diagnostic workup. In the presence of characteristic signs and symptoms, patients should be asked about their occupancy and whether exposure to toluene could have possibly occurred at the workplace, while intentional abuse must also be excluded. Laboratory studies, particularly the acid-base status and urinalysis, is the next step in solidifying clinical suspicion, showing hypokalemia, hypophosphatemia and a normal (or sometimes elevated) anion gap acidosis [1] [2] [3] [5]. In addition, kidney function tests will reveal elevated creatine kinase (CK) levels in the presence of renal impairment, whereas severely acidic urine is also a common feature [2] [3]. Some studies have confirmed that chronic toluene poisoning leads to marked structural changes and demyelination in the CNS, and typical findings on magnetic resonance imaging (MRI) include lesions of the white matter that transmit a hyperintense signal on T2-weighted studies and hypointensity of the thalamus [6]. Thus, imaging studies may be beneficial in the presence of neurological deficits.

Treatment

  • Treatment with agonists of GABA such as, benzodiazepines provide some mitigation of earthquakes induced by toluene, as ataxia. An alternative to drug treatment is the thalamotomie.[dd-database.org]
  • […] wash out the stomach ( gastric lavage ) Surgery to remove burned skin Breathing support, including tube through the mouth into the lungs and breathing machine (ventilator) How well someone does depends on how severe the poisoning is and how quickly treatment[medlineplus.gov]
  • In all cases, it is imperative that you seek medical treatment straight away. Making your claim for toluene poisoning Before you begin your claim for poisoning in an industrial setting you should first ascertain what your symptoms are.[jefferies-solicitors.com]
  • Researches at a national shell filling factory TNT poisoning TNT solvents and protective varnishes for the skin Toxic effects of TNT compared with those of Di-nitro-phenol Toxic jaundice and aplastic anemia as a result of increased hemoglobin metabolism Treatment[momicoh.pastperfectonline.com]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]

Prognosis

  • Altered mental status Dysrhythmias Hepatic dysfunction Renal failure Rhabdomyolysis Severe metabolic derangements Refractory hypokalemia Myocardial sensitization to catecholamines: Possibility of sudden dysrhythmia/death Cardiac dysrhythmias have poor prognosis[5minuteconsult.com]

Etiology

  • Although any of these could be considered the etiology of intestinal obstruction, we could not find any tumors, obvious intestinal adhesions, hernias, inflammatory bowel diseases, volvulus or intussusceptions in clinical and paraclinical evaluations and[theijoem.com]

Epidemiology

  • […] concentration and motor performance deficits. [4] Toluene has also been listed as a known human respiratory toxicant by the Environmental Protection Agency. [3] Exposure to toluene in humans can result in respiratory tract irritation. [2] Additionally, in human epidemiological[safecosmetics.org]
  • .: Epidemiology of thinner-sniffing [in Japanese with English abstrat], Japan. J.[link.springer.com]
Sex distribution
Age distribution

Prevention

  • M46 Catalog Number 2016.25.249 Author Moore, Benjamin Summary The Causation and Prevention of Tri-Nitro-Toluene Poisoning; 1917.[momicoh.pastperfectonline.com]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Take the container to the hospital with you, if possible.[medlineplus.gov]
  • This case report suggests that patient after toluene exposure needs immediate medical attention to prevent death. References 1. United States Department of Labor. Occupational Safety and Health Administration. Safety and Health topics: Toluene.[mjdrdypu.org]

References

Article

  1. Camara-Lemarroy CR, Rodríguez-Gutiérrez R, Monreal-Robles R, González-González JG. Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study. BMC Emerg Med. 2015;15:19.
  2. Omar AS, Rahman M ur, Abuhasna S. Reported survival with severe mixed acidosis and hyperlactemia after toluene poisoning. Saudi J Anaesth. 2011;5(1):73-75.
  3. Dickson RP, Luks AM. Toluene toxicity as a cause of elevated anion gap metabolic acidosis. Respir Care. 2009;54(8):1115-1117.
  4. Carlisle EJ, Donnelly SM, Vasuvattakul S, Kamel KS, Tobe S, Halperin ML. Glue-sniffing and distal renal tubular acidosis: sticking to the facts. J Am Soc Nephrol 1991;1:1019e27.
  5. Tsao JH, Hu YH, How CK, et al. Atrioventricular conduction abnormality and hyperchloremic metabolic acidosis in toluene sniffing. J Formos Med Assoc. 2011;110(10):652-654.
  6. Aydin K, Sencer S, Demir T, Ogel K, Tunaci A, Minareci O. Cranial MR findings in chronic toluene abuse by inhalation. AJNR Am J Neuroradiol. 2002;23(7):1173-1179.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 06:23