A “glue sniffer” teenager with anuric renal failure and hepatitis

Abstract

“Inhalant abuse” is a common form of volatile drug abuse throughout theworld especially in developing countries. This substance mainly containstoluene. Acute toluene inhalation produces a biphasic response with an initialcentral nervous system (CNS) excitation followed by CNS depression as wellas various metabolic alterations. Chronic inhalational abuse is associated withmuscular weakness, gastrointestinal symptoms, renal and hepatic injury. Inthis report, a 16-year-old boy presented with jaundice, nausea, vomiting andreduced urine output. He developed severe acute renal/hepatic damage dueto abuse of gas products. Since toluene is the main toxic agent involved inglue sniffing which is metabolized to hippuric acid, the present case wastreated with continuous hemodiafiltration, plasma exchange and conservativetherapy to eliminate hippuric acid. The jaundice gradually disappeared, hehad complete recovery of renal/hepatic functions in ten days. We aimed toincrease the awareness among emergency physicians that ‘’glue sniffing’’should be considered in the differential diagnosis of unexplained reversibleacute renal/hepatic damage.