Volatile Substance Toxicity - Diagnosis and Management

Introduction

Many volatile chemicals have similar acute toxicity, primarily influenced by physical features rather than chemical structure. The problems associated with solvent inhalation are potentially harmful. They must be recognized by the primary care physician, even though the abuse of volatile substances (VSA) like toluene, aromatic hydrocarbons, or butane does not generate the same attention as the use of cocaine, marijuana, or heroin. Abusers of volatile substances enjoy pleasure and impulsive behavior, but these effects are often followed by nausea, vomiting, dizziness, coughing, and increased salivation. In more severe situations, cardiac rhythms, convulsions, coma, and death can also arise.

What Is a Volatile Substance?

The solvents that are liquid or semi-solid, which vaporize at room temperature into glues or gasoline, are called volatile substances. Various volatile components are found in easily accessible consumer or commercial goods like spray paint, deodorant, and hair spray, which can transfer into a gaseous form. When their vapors are intentionally condensed and inhaled, it results in harmful effects like volatile substance toxicity or poisoning and, in some cases, even leads to life-threatening situations. Alkyl nitrites are a particular subclass of volatile chemicals popular in dance clubs because of their muscle relaxant effect. They may induce a "rush," which can be used to enhance sexual intercourse. They are sometimes referred to as "poppers" and are sold on the "street" in pubs and clubs.

How Does a Volatile Substance Act in the Human Body?

Hydrocarbons quickly evaporate at room temperature and are known as volatile solvents. These substances are inhaled by the lungs and entered into the blood circulation. Solvents predominantly reach other organs with a substantial amount of fat, including the brain, due to their strong lipid solubility. Isolated compounds are eliminated in the urine after hepatic metabolism, and most chemicals are eliminated directly through the lungs. Due to the high euphoria, chronic users prefer toluene-based solvents.

What Volatile Substances Are Available in the Market?

The volatile liquids or gases in various household, industrial, or pharmaceutical products are frequently available to the general public in various stores, workplaces, or laboratories. The nitrite-containing goods or poppers are frequently contaminated and typically contain butyl or isobutyl nitrite. The items are often sold in little glass bottles with suggestive names. The odor is unique, sweet, and unpleasant; it has been compared to the smell of "old socks." The most common volatile substances are

• Butane, iso-butane, propane, and liquefied petroleum gas (LPG) are used in fuel gases and propellants.

• Gasoline.

• Petrol.

• Benzin.

• Tetrachloroethene and perchloroethylene are used as dry-cleaning solvents and typewriter correction fluids.

• Helium gas is readily used in party balloons.

• Toluene-based solvents used in paints, thinner, and glues induce a high euphoria and are hence typically preferred by chronic users.

• Amyl nitrite is an isomeric mixture employed as a cyanide antidote and poppers.

What Is the Mode of Use of Volatile Substances That Get Abused?

The mode of use depends on the nature of the substance, and it is distinguished into three types.

• Sniffing: Direct inhalation of gases from containers, such as cigarette lighter refills, is known as sniffing.

• Bagging: It is done by pouring the solvent into a bag. Toluene or other solvents can be spilled upon a handkerchief or bag, and the vapor can then be inhaled.

• Huffing: It is the act of breathing vapors while covering the mouth and nose with a cloth soaked in a solvent like cloth or sock.

What Are the Toxic Effects of Volatile Substances?

The toxic effects are based on the volatile compound type, mode, and duration of usage. Abusers frequently experience some kind of intoxication, ranging from mild euphoria (happiness or well-being) to psychosis. Most solvents can potentially cause

• Cardiovascular abnormalities, including irregular heartbeat, acute hypertension, and decreased cardiac activity.

• Neurologic dysfunction.

• Hypoxia (oxygen insufficiency).

• Blurry vision.

• Photophobia (fear of light).

• Tinnitus (buzzing noise in the ear).

• Slurred speech.

• Headache.

• Stomach pain.

• Drooling of the mouth or salivation.

• Coughing and sneezing

• Bronchospasm (tightening of the muscles around the lungs).

How to Diagnose Volatile Substances Toxicity?

The diagnosis is made by the smell of gasoline or solvents on the breath, clothing, or hair. The smell of solvents is strongest on the breath, which can be detected for hours because many solvents are exhaled through the lungs. The clear clinical feature does not exhibit volatile toxicity. However, during a physical examination, an erythematous rash might be encountered around the mouth due to repetitive inhalation. This is also known as "glue sniffer's rash." Rarely, the midface may have been marked with acrylic paint, typewriter correction fluid, or adhesive. In recent advancements, vapor phase infra-red spectrophotometry or gas chromatography (GC) can examine the volatile substance.

How to Manage Volatile Substances Toxicity?

1. The primary management of intoxication involves assessing and stabilizing the airway, breathing, and circulation.

2. Most of the inhalent who are intoxicated can recover without any treatment, although some may require oxygen supply.

3. Butane cigarette lighter fluid has resulted in greater incidents of burns.

4. They often only require a two-to-day of hospitalization. but it might be much worse if the patient is unconscious when the fire starts.

5. Life-threatening like electrolyte imbalances and metabolic acidosis associated with intoxication.

6. Methemoglobin is treated with methylene blue, while carboxyhemoglobin is treated with oxygen.

7. A complete blood count, urinalysis, electrolytes, blood urea nitrogen (BUN), creatinine, and liver function testing may be assessed to identify long-term pathophysiologic effects.

8. Electrolytes are crucial for assessing anion gap acidosis, the blood count aids in determining hematologic toxicity, the urine, BUN, and creatinine indicate renal impairment, and the liver investigations characterize any hepatotoxicity.

9. Regular urine and serum drug tests cannot find these addictive drugs. If the diagnosis is uncertain, salicylate and toxic alcohol levels should be considered.

Conclusion

Oversage of volatile substances has become a significant health concern, particularly in younger teens. Inhalants are simple to acquire. Short- and long-term consequences are linked to significant morbidity and, in some circumstances, even mortality when dealing with patients who appear intoxicated or have exhibited a change in attitude, diagnosed by primary healthcare professionals with the help of signs, symptoms, and complications of Versatile toxicity.