Metabolic acidosis toluene

Inhalant intoxication dehrium can occur as a consequence of disturbances in dopaminergic, glutamatergic, and GABAergic neu to transmission secondary to acute, high-level exposure to psychoactive ingredients in solvents such as toluene, trichloroethane, and trichloroethylene. Systemic effects of solvent inhalation such as cerebral hypoxia and/or metabolic acidosis may also be involved (Rosenberg 1982). Under these circumstances, inhalant intoxication dehrium develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. Usually, the delirium resolves as the intoxication ends or within a few hours after cessation of use. 

Several cases of severe metabolic acidosis after recreational toluene sniffing have been described renal tubule damage has been proposed as the pathogenetic mechanism (Batlle et al., 1988 Goodwin, 1988 Pearson et al., 1994 Hong et al., 1996). 

Hypokalemia is a common accompaniment of the metabolic acidosis that toluene inhalation can cause (see below). However, severe hypokalemia has also been reported in the absence of acidosis (31). 

There have been many anecdotal reports of metabolic acidosis in glue sniffers, attributed to renal tubular acidosis. However, it has been suggested that it is in fact due to overproduction of hippuric acid resulting from the metabolism of toluene, with or without a reduced rate of urinary ammonium ion excretion (32). 

This sulfonamide (a-amino-p-toluene-sulfonamide) is marketed as mafenide acetate (sulfamy-lon). It is used topically to prevent colonization of bums by a large variety of gram-negative and gram-positive bacteria. It is associated with significant adverse effects, including intense pain at sites of application, allergic reactions, loss of fluid by evaporation from the bum surface, and metabolic acidosis secondary to inhibition of carbonic anhydrase. 

Metabolism A 47-year-old woman developed a severe metabolic acidosis with a raised anion gap [100" ]. She had a chronic distal renal tubular acidosis, which was attributed to chronic toluene toxicity secondary to paint thinner and spray paint inhalation. 

Dickson RP, Luks AM. Toluene toxicity as a cause of elevated anion gap metabolic acidosis. Respir Care 2009 54(8) 1115-7. 

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See also in sourсe #XX -- [ ]

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