Inhalant Intoxication

• In the United States, about 0.4% of individuals ages 12 to 17 years have a pattern of use that meets criteria for inhalant use disorder in the past year.^[2]
  • It can be inferred that there is a similar rate of inhalant intoxication based on these prevalence numbers.
• Similar to inhalant use disorder, inhalant intoxication occurs the greatest in the age range between 12-17 years.^[3]
• In the United States, in those >12 years, approximately 1% of males and 0.7% of females have used inhalants in the previous year.

• Inhalant intoxication usually clears within a few minutes to a few hours when the exposure ends.^[4]
• During the period of intoxication, if an individual uses an inhaled substance in a closed container, such as a plastic bag over the head, this can lead to unconsciousness, anoxia, or death.^[5]
  • In rare cases, there have been inhalant-related accidents, or “sudden sniffing death” From sudden cardiac arrhythmias.^[6]
  • Certain volatile inhalants (e.g. - butane, propane) have greater toxicity and risk.^[7]

Recent intended or unintended short-term, high-dose exposure to inhalant substances, including volatile hydrocarbons such as toluene or gasoline.

Clinically significant problematic behavioural or psychological changes (e.g. - belligerence, assaultiveness, apathy, impaired judgment) that developed during, or shortly after, exposure to inhalants.

At least 2 of the following signs or symptoms developing during, or shortly after, inhalant use or exposure:

1. Dizziness
2. Nystagmus
3. Incoordination
4. Slurred speech
5. Unsteady gait
6. Lethargy
7. Depressed reflexes (i.e. - hyporeflexia)
8. Psychomotor retardation
9. Tremor
10. Generalized muscle weakness
11. Blurred vision or diplopia
12. Stupor or coma
13. Euphoria

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

• Intoxication symptoms include disinhibition, euphoria, slurred speech, disturbed gait, disorientation, drowsiness.
  • There are also prominent neurological exam findings, including tremors and hyporeflexia.
• Although inhalant withdrawal a DSM-5 diagnosis withdrawal symptoms can include irritability, dysphoria, sleep disturbance, headaches.

• Inhalant exposure, without meeting the criteria for inhalant intoxication disorder
  • The individual intentionally or unintentionally inhaled substances, but the dose was insufficient for the criteria for inhalant use disorder.
• Intoxication and other substance/medication-induced disorders from other substances, especially from sedating substances (e.g. - alcohol, benzodiazepines, barbiturates)
  • Other substance use disorders may have a similar presentation. A diagnosis of inhalant intoxication may be suggested by possession of inhalants, odours of inhalant substances (e.g. - glue, paint thinner, gasoline, butane lighters), paraphernalia (e.g. - bags for concentrating glue fumes), a perioral or perinasal “glue-sniffer's rash,” reports from loved ones that the individual uses inhalants, apparent intoxication despite negative drug screens, apparent intoxication between the ages of 12 to 17 years (range with highest prevalence), association with others who use inhalants, connection to communities with higher rates of inhalant use, or unusual access to inhalants (e.g. - works in industrial environment).
• Other inhalant-related disorders
  • Other inhalant-related disorders include inhalant use disorder, inhalant-induced neurocognitive disorder, inhalant-induced psychotic disorder, inhalant-induced depressive disorder, inhalant-induced anxiety disorder, and other inhalant-induced disorders.
• Other toxic, metabolic, traumatic, neoplastic, or infectious disorders that impair brain function and cognition
  • Numerous other neurological and medical conditions can mimic the behavioural or psychological changes (e.g. - belligerence, assaultiveness, apathy, impaired judgment) seen in inhalant intoxication.

• Standard drug screens do not detect inhalants, and will show up as negative.^[8]
  • Urine, breath, or saliva tests may be helpful to assess for non-inhalant substances for individuals with inhalant use disorder.^[9]
  • Inhalant-specific diagnostic assays and tests are expensive, and thus not practical in routine clinical practice.
• Bloodwork may show rhabdomyolysis.

• Inhalant intoxication is usually self-limiting and resolves on its own
• The majority of treatment and management focuses on addressing the underlying inhalant use disorder.