UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Inhalant abuse in children and adolescents

Author
Holly Perry, MD
Section Editor
Michele M Burns, MD, MPH
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

The epidemiology, clinical manifestations, toxic effects, and management of inhalant use will be reviewed here. Substances that are snorted (eg, cocaine) or smoked (eg, tobacco, marijuana, cocaine, and opiates) are discussed separately. (See "Cocaine: Acute intoxication" and "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Treatment of cannabis use disorder" and "Opioid intoxication in children and adolescents".)

EPIDEMIOLOGY

In the United States, inhalant abuse is common with approximately 11 percent of high school students reporting having used inhalants in their lifetime [1]. An estimated 6 in 1000 United States children between the age of 12 and 17 are currently abusing inhalants [2,3]. Unlike nearly all other classes of drugs, their use is most common among younger adolescents with use peaking between seventh and ninth grade [4].

The incidence of inhalant abuse in children 12 to 18 years old has fluctuated over the past 25 years. Incidence of use tripled between 1983 and 1993 [5], peaking in 1995, and then showed a steady decline until 2002. Incidence was unchanged for the next 11 years but showed a significant decrease in 2013 [3,4]. Unlike other drugs of abuse, male and female adolescents report a similar rate of inhalant abuse [2]. In the past, Native American children and those residing in rural areas were at higher risk for inhalant abuse [6-10]. However, rates of abuse have fallen steadily in these groups and are now at levels comparable to the general population. Education on prevention and treatment is thought to be responsible for this trend [11,12].

Similar to national survey data, exposures in 12 to 17 year old patients reported to United States regional poison control centers declined from 73 cases per million in 1993 to 33 cases per million in 2003, and the peak age of exposure was 14 years [9]. Among all patients, there were 167 deaths out of 35,453 exposures between 1993 and 2008. Butane, propane, and air fresheners were associated with the highest fatality rate. Males comprised 73 percent of all cases reported to poison centers suggesting that boys may have riskier inhalant abuse behaviors. In the United Kingdom, deaths due to volatile substance abuse peaked in the early 1990s and subsequently have declined after education campaigns and laws prohibiting cigarette lighter refills went into effect [13].

Numerous studies have demonstrated significant mental health and behavioral comorbidities among patients who are inhalant abusers. They are more likely to have an episode of major depression [2,14,15], suicidality [16], conduct disorder [14], and are at an increased risk for future drug abuse problems [17].

                          
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 27, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2011. MMWR Surveill Summ 2012; 61:1.
  2. Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD.
  3. SAMHSA. Behavioral health trends in the United States: Results from the 2014 national survey on drug use and health. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf (Accessed on August 29, 2016).
  4. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future National Results on Adolescent Drug Abuse: Overview of Key Findings, 2010. 2011. http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2010.pdf (Accessed on November 30, 2011).
  5. Neumark YD, Delva J, Anthony JC. The epidemiology of adolescent inhalant drug involvement. Arch Pediatr Adolesc Med 1998; 152:781.
  6. Osterhoudt KC, Burns Ewald M, Shannon M, Henretig FM. Toxicologic emergencies. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.951.
  7. Beauvais F. Comparison of drug use rates for reservation Indian, non-reservation Indian and Anglo youth. Am Indian Alsk Native Ment Health Res 1992; 5:13.
  8. Spiller H, Lorenz DJ. Trends in volatile substance abuse. J Addict Dis 2009; 28:164.
  9. Marsolek MR, White NC, Litovitz TL. Inhalant abuse: monitoring trends by using poison control data, 1993-2008. Pediatrics 2010; 125:906.
  10. Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E. & Miech, R. A. (2014). Monitoring the Future national survey results on drug use, 1975–2013: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available at http://monitoringthefuture.org/pubs/monographs/mtf-vol1_2013.pdf (Accessed July 14, 2014)
  11. Beauvais F, Jumper-Thurman P, Burnside M. The changing patterns of drug use among American Indian students over the past 30 years. Am Indian Alsk Native Ment Health Res 2008; 15:15.
  12. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. (December 18, 2013). "American teens more cautious about using synthetic drugs." University of Michigan News Service: Ann Arbor, MI. http://www.monitoringthefuture.org (Accessed on July 20, 2014).
  13. Butland BK, Field-Smith ME, Ramsey JD, Anderson HR. Twenty-five years of volatile substance abuse mortality: a national mortality surveillance programme. Addiction 2013; 108:385.
  14. Howard MO, Walker RD, Walker PS, et al. Inhalant use among urban American Indian youth. Addiction 1999; 94:83.
  15. Sakai JT, Hall SK, Mikulich-Gilbertson SK, Crowley TJ. Inhalant use, abuse, and dependence among adolescent patients: commonly comorbid problems. J Am Acad Child Adolesc Psychiatry 2004; 43:1080.
  16. Freedenthal S, Vaughn MG, Jenson JM, Howard MO. Inhalant use and suicidality among incarcerated youth. Drug Alcohol Depend 2007; 90:81.
  17. Johnson EO, Schütz CG, Anthony JC, Ensminger ME. Inhalants to heroin: a prospective analysis from adolescence to adulthood. Drug Alcohol Depend 1995; 40:159.
  18. McHugh MJ. The abuse of volatile substances. Pediatr Clin North Am 1987; 34:333.
  19. Kurtzman TL, Otsuka KN, Wahl RA. Inhalant abuse by adolescents. J Adolesc Health 2001; 28:170.
  20. Chadwick O, Anderson R, Bland M, Ramsey J. Neuropsychological consequences of volatile substance abuse: a population based study of secondary school pupils. BMJ 1989; 298:1679.
  21. Deitrich RA, Dunwiddie TV, Harris RA, Erwin VG. Mechanism of action of ethanol: initial central nervous system actions. Pharmacol Rev 1989; 41:489.
  22. Jevtović-Todorović V, Todorović SM, Mennerick S, et al. Nitrous oxide (laughing gas) is an NMDA antagonist, neuroprotectant and neurotoxin. Nat Med 1998; 4:460.
  23. Sanders RD, Weimann J, Maze M. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology 2008; 109:707.
  24. Harris D, Mirza Z. Butane encephalopathy. Emerg Med J 2005; 22:676.
  25. A campaign to prevent inhalant abuse. Bureau of Substance Abuse Services, Massachusetts Department of Public Health.
  26. Dinwiddie SH. Abuse of inhalants: a review. Addiction 1994; 89:925.
  27. Henretig F. Inhalant abuse in children and adolescents. Pediatr Ann 1996; 25:47.
  28. Espeland K. Identifying the manifestations of inhalant abuse. Nurse Pract 1995; 20:49.
  29. Brust JC. Other agents. Phencyclidine, marijuana, hallucinogens, inhalants, and anticholinergics. Neurol Clin 1993; 11:555.
  30. McManus B. Hydrocarbons. In: Pediatric Emergency Medicine: A Comprehensive Study Guide, Strange GR, Ahrens W, Lelyveld S, Schafermeyer R (Eds), McGraw Hill, New York 1996. p.538.
  31. Bass M. Sudden sniffing death. JAMA 1970; 212:2075.
  32. Hernberg S. Lead poisoning in a historical perspective. Am J Ind Med 2000; 38:244.
  33. Kurbat RS, Pollack CV Jr. Facial injury and airway threat from inhalant abuse: a case report. J Emerg Med 1998; 16:167.
  34. Wegener EE, Barraza KR, Das SK. Severe frostbite caused by Freon gas. South Med J 1991; 84:1143.
  35. Gerhardt RT. Acute Halon (bromochlorodifluoromethane) toxicity by accidental and recreational inhalation. Am J Emerg Med 1996; 14:675.
  36. Scalzo AJ. Inhalation injuries. In: Pediatric Emergency Medicine: Concepts and Clinical Practice, Barkin RM (Ed), Mosby, St. Louis 1997. p.594.
  37. Weaver MF, Jarvis MA, Schnoll SH. Role of the primary care physician in problems of substance abuse. Arch Intern Med 1999; 159:913.
  38. Lolin Y. Chronic neurological toxicity associated with exposure to volatile substances. Hum Toxicol 1989; 8:293.
  39. Tormoehlen LM, Tekulve KJ, Nañagas KA. Hydrocarbon toxicity: A review. Clin Toxicol (Phila) 2014; 52:479.
  40. Shepherd RT. Mechanism of sudden death associated with volatile substance abuse. Hum Toxicol 1989; 8:287.
  41. Yücel M, Takagi M, Walterfang M, Lubman DI. Toluene misuse and long-term harms: a systematic review of the neuropsychological and neuroimaging literature. Neurosci Biobehav Rev 2008; 32:910.
  42. Fornazzari L, Wilkinson DA, Kapur BM, Carlen PL. Cerebellar, cortical and functional impairment in toluene abusers. Acta Neurol Scand 1983; 67:319.
  43. Rosenberg NL, Spitz MC, Filley CM, et al. Central nervous system effects of chronic toluene abuse--clinical, brainstem evoked response and magnetic resonance imaging studies. Neurotoxicol Teratol 1988; 10:489.
  44. Filley CM, Heaton RK, Rosenberg NL. White matter dementia in chronic toluene abuse. Neurology 1990; 40:532.
  45. Filley CM, Kleinschmidt-DeMasters BK. Toxic leukoencephalopathy. N Engl J Med 2001; 345:425.
  46. Küçük NO, Kiliç EO, Ibis E, et al. Brain SPECT findings in long-term inhalant abuse. Nucl Med Commun 2000; 21:769.
  47. Fortenberry JD. Gasoline sniffing. Am J Med 1985; 79:740.
  48. Gallassi R, Montagna P, Pazzaglia P, et al. Peripheral neuropathy due to gasoline sniffing - A case report. Eur Neurol 1980; 19:419.
  49. Kovanen J, Somer H, Schroeder P. Acute myopathy associated with gasoline sniffing. Neurology 1983; 33:629.
  50. Maruff P, Burns CB, Tyler P, et al. Neurological and cognitive abnormalities associated with chronic petrol sniffing. Brain 1998; 121 ( Pt 10):1903.
  51. Tenenbein M. Leaded gasoline abuse: the role of tetraethyl lead. Hum Exp Toxicol 1997; 16:217.
  52. Cairney S, O' Connor N, Dingwall KM, et al. A prospective study of neurocognitive changes 15 years after chronic inhalant abuse. Addiction 2013; 108:1107.
  53. Carder JR, Fuerst RS. Myocardial infarction after toluene inhalation. Pediatr Emerg Care 1997; 13:117.
  54. Alper AT, Akyol A, Hasdemir H, et al. Glue (toluene) abuse: increased QT dispersion and relation with unexplained syncope. Inhal Toxicol 2008; 20:37.
  55. Adgey AA, Johnston PW, McMechan S. Sudden cardiac death and substance abuse. Resuscitation 1995; 29:219.
  56. Poklis A. Letter: Sudden sniffing death. Can Med Assoc J 1976; 115:208.
  57. Nelson LS. Toxicologic myocardial sensitization. J Toxicol Clin Toxicol 2002; 40:867.
  58. Fitzgerald RL, Fishel CE, Bush LL. Fatality due to recreational use of chlorodifluoromethane and chloropentafluoroethane. J Forensic Sci 1993; 38:477.
  59. de la Hoz RE. Reactive airways dysfunction syndrome following exposure to a fluorocarbon. Eur Respir J 1999; 13:1192.
  60. Marjot R, McLeod AA. Chronic non-neurological toxicity from volatile substance abuse. Hum Toxicol 1989; 8:301.
  61. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance--United States, 2007. MMWR Surveill Summ 2008; 57:1.
  62. Streicher HZ, Gabow PA, Moss AH, et al. Syndromes of toluene sniffing in adults. Ann Intern Med 1981; 94:758.
  63. Taher SM, Anderson RJ, McCartney R, et al. Renal tubular acidosis associated with toluene "sniffing". N Engl J Med 1974; 290:765.
  64. VIGLIANI EC, SAITA G. BENZENE AND LEUKEMIA. N Engl J Med 1964; 271:872.
  65. Rosner F, Grünwald HW. Cytotoxic drugs and leukaemogenesis. Clin Haematol 1980; 9:663.
  66. Shih RD. Hydrocarbons. In: Toxicological Emergencies, Goldfrank LR, Flomenbaum NE, Lewin NA, et al (Eds), Appleton and Lange, Stamford 1998. p.1384.
  67. Sturmann K, Mofenson H, Caraccio T. Methylene chloride inhalation: an unusual form of drug abuse. Ann Emerg Med 1985; 14:903.
  68. Carlisle EJ, Donnelly SM, Vasuvattakul S, et al. Glue-sniffing and distal renal tubular acidosis: sticking to the facts. J Am Soc Nephrol 1991; 1:1019.
  69. Jones HE, Balster RL. Inhalant abuse in pregnancy. Obstet Gynecol Clin North Am 1998; 25:153.
  70. Arnold GL, Kirby RS, Langendoerfer S, Wilkins-Haug L. Toluene embryopathy: clinical delineation and developmental follow-up. Pediatrics 1994; 93:216.
  71. Khattak S, K-Moghtader G, McMartin K, et al. Pregnancy outcome following gestational exposure to organic solvents: a prospective controlled study. JAMA 1999; 281:1106.
  72. Boynukalin FK, Baykal C. Prenatal diagnosis of multiple fetal anomalies in naphthalene-addicted pregnant women: a case report. Clin Exp Obstet Gynecol 2014; 41:217.
  73. Hersh JH. Toluene embryopathy: two new cases. J Med Genet 1989; 26:333.
  74. Tenenbein M, Casiro OG, Seshia MM, Debooy VD. Neonatal withdrawal from maternal volatile substance abuse. Arch Dis Child Fetal Neonatal Ed 1996; 74:F204.
  75. Broussard LA, Brustowicz T, Pittman T, et al. Two traffic fatalities related to the use of difluoroethane. J Forensic Sci 1997; 42:1186.
  76. Bowen SE, Daniel J, Balster RL. Deaths associated with inhalant abuse in Virginia from 1987 to 1996. Drug Alcohol Depend 1999; 53:239.
  77. Layzer RB, Fishman RA, Schafer JA. Neuropathy following abuse of nitrous oxide. Neurology 1978; 28:504.
  78. Vishnubhakat SM, Beresford HR. Reversible myeloneuropathy of nitrous oxide abuse: serial electrophysiological studies. Muscle Nerve 1991; 14:22.
  79. Cartner M, Sinnott M, Silburn P. Paralysis caused by "nagging". Med J Aust 2007; 187:366.
  80. Iwata K, O'Keefe GB, Karanas A. Neurologic problems associated with chronic nitrous oxide abuse in a non-healthcare worker. Am J Med Sci 2001; 322:173.
  81. Miller MA, Martinez V, McCarthy R, Patel MM. Nitrous oxide "whippit" abuse presenting as clinical B12 deficiency and ataxia. Am J Emerg Med 2004; 22:124.
  82. Sethi NK, Mullin P, Torgovnick J, Capasso G. Nitrous oxide "whippit" abuse presenting with cobalamin responsive psychosis. J Med Toxicol 2006; 2:71.
  83. Kaufman B, Sutin KM, Wahlander S, Miller SM. Anesthetics and neuromuscular blocking agents. In: Goldfrank's Toxicologic Emergencies, 6th, Goldfrank CR, Flomenbaum NE, Lewin NA, et al (Eds), Appleton & Lange, Stamford 1998. p.873.
  84. Amos RJ, Amess JA, Hinds CJ, Mollin DL. Incidence and pathogenesis of acute megaloblastic bone-marrow change in patients receiving intensive care. Lancet 1982; 2:835.
  85. Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol 2006; 5:949.
  86. Wrońska-Nofer T, Palus J, Krajewski W, et al. DNA damage induced by nitrous oxide: study in medical personnel of operating rooms. Mutat Res 2009; 666:39.
  87. Garbaz L, Mispelaere D, Boutemy M, Jounieaux V. [Pneumothorax following recreational inhalation of nitrous oxide]. Rev Mal Respir 2007; 24:622.
  88. Haverkos HW, Kopstein AN, Wilson H, Drotman P. Nitrite inhalants: history, epidemiology, and possible links to AIDS. Environ Health Perspect 1994; 102:858.
  89. Haverkos HW, Dougherty J. Health hazards of nitrite inhalants. Am J Med 1988; 84:479.
  90. Lange WR, Fralich J. Nitrite inhalants: promising and discouraging news. Br J Addict 1989; 84:121.
  91. Bogart L, Bonsignore J, Carvalho A. Massive hemolysis following inhalation of volatile nitrites. Am J Hematol 1986; 22:327.
  92. Coleman MD, Coleman NA. Drug-induced methaemoglobinaemia. Treatment issues. Drug Saf 1996; 14:394.
  93. Bradberry SM, Whittington RM, Parry DA, Vale JA. Fatal methemoglobinemia due to inhalation of isobutyl nitrite. J Toxicol Clin Toxicol 1994; 32:179.
  94. Edwards KE, Wenstone R. Successful resuscitation from recurrent ventricular fibrillation secondary to butane inhalation. Br J Anaesth 2000; 84:803.
  95. Mortiz F, de La Chapelle A, Bauer F, et al. Esmolol in the treatment of severe arrhythmia after acute trichloroethylene poisoning. Intensive Care Med 2000; 26:256.
  96. Gindre G, Le Gall S, Condat P, Bazin JE. [Late ventricular fibrillation after trichloroethylene poisoning]. Ann Fr Anesth Reanim 1997; 16:202.
  97. Cámara-Lemarroy CR, Gónzalez-Moreno EI, Rodriguez-Gutierrez R, González-González JG. Clinical presentation and management in acute toluene intoxication: a case series. Inhal Toxicol 2012; 24:434.