Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

BMC Emergency Medicine

José Gerardo González-González¹  Roberto Monreal-Robles²  René Rodríguez-Gutiérrez⁴  Carlos Rodrigo Camara-Lemarroy³ 

[1] Departamento de Medicina Interna, Servicio de Endocrinología, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, N.L. México, Madero y Gonzalitos S/N, Monterrey 64460, NL, Mexico;Departamento de Medicina Interna, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, N.L. México, Madero y Gonzalitos S/N, Monterrey 64460, NL, México;Servicio de Neurología, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, N.L. México, Madero y Gonzalitos S/N, Monterrey 64460, NL, Mexico;Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester 55905, MN, USA

关键词: Hypokalemia;    Renal tubular acidosis;    Rhabdomyolysis;    Toxicity;    Toluene;   

Others  :  1231102
DOI  :  10.1186/s12873-015-0039-0

 received in 2014-08-03, accepted in 2015-06-29,  发布年份 2015

【 摘 要 】

Background

Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication.

Methods

We prospectively assessed 20 patients that were admitted to a single center’s emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication.

Results

The main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80 % of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities.

Conclusion

The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.

【 授权许可】

   
2015 Camara-Lemarroy et al.

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