Overview
Inhalant use may be observed through the breathing in of fumes produced by volatile hydrocarbons, or inhalants.
A problematic pattern of usage may develop, and the inhalation of these substances can lead to intoxication among individuals, manifesting as behavioural and psychological changes, as well as symptoms such as dizziness, slurred speech, unsteady gait, vision problems, and so on.
The prevalence of Inhalant Intoxication is considered to be similar to that of Inhalant Use Disorder. The aetiology of both may also be closely interlinked, as the use of inhalants typically leads to intoxication.
A range of factors including genetic, temperamental, and environmental factors have been implicated. Treatment for Inhalant Intoxication is based largely on primary treatment and supportive care, as no medication has been identified in reversing the effects of intoxication due to inhalants.
Signs and Symptoms
The signs and symptoms of Inhalant Intoxication may be observable after recent exposure to inhalant substances, and may include:
- Behavioral changes such as aggression
- Psychological changes such as apathy or impaired judgement
- Dizziness
- Uncontrollable and repetitive movement of the eyes
- Problems in coordination
- Slurred speech
- Walking unsteadily
- Lethargy
- Slow reflexes and movement
- Tremor
- Muscle weakness
- Blurred vision
- Stupor or coma
- Euphoria
Risk Factors
The prevalence of Inhalant Intoxication is largely unknown. However, it is speculated that a significant amount of individuals who engage in inhalant use also experience inhalant intoxication, suggesting a similar prevalence.
Taking this into consideration, sex based differences are unlikely to exist in the prevalence Inhalant Intoxication, and the primary demographic likely consists of adolescent populations, concentrated mainly among 12-17 year olds.
Aetiological factors leading to Inhalant Use Disorder may also be implicated in Inhalant Intoxication, as the prolonged use of inhalants is associated with intoxication.
In accordance with the same, genetic factors associated with behavioural disinhibition, environmental factors involving availability of inhalants, stressful life events, abusive or negligent parenting, and social patterns may be taken into consideration.
Further, the presence of comorbidities such as mood and anxiety disorders, panic disorder, antisocial personality disorder, substance use disorders and conduct disorder may be associated with a pattern of chronic inhalant use and intoxication.
According to research, the use of inhalants leads to dissociative feelings, or euphoria, often referred to as a temporary โhighโ, which may be responsible for reinforcing persistent use.
However, a study suggested that while acute use of inhalants was associated with more euphoric states, the long-term use of the substances was significantly associated with aversive experiences.
According to existing data, individuals feel inclined towards the use of inhalants due to factors such as curiosity, boredom, ease of access, as well as the experience of negative emotions.
Inhalants are also considered to be relatively inexpensive substances, which may explain a higher prevalence among socioeconomically disadvantaged populations.
Diagnosis
The diagnosis of Inhalant Intoxication may be challenging since the symptoms closely match those of other substance use disorders, and standard drug tests may not detect inhalant substances. Owing to this, the initial part of the diagnostic process may primarily focus on obtaining a clinical history, including questions about inhalant possession and use.
The determination of Inhalant Intoxication may also be made on the basis of proof of possession of inhalant substances, for instance, the possession of aerosol cans or paint thinner.
Inhalant substances usually have strong smells, which may remain on the body of the individual after use. This can also be instrumental in diagnosis.
The DSM-5 provides the following criteria for the diagnosis of Inhalant Intoxication:
- 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.
- Two (or more) of the following signs or symptoms developing during, or shortly after, inhalant use or exposure:
- Dizziness.
- Nystagmus.
- Incoordination.
- Slurred speech.
- Unsteady gait.
- Lethargy.
- Depressed reflexes.
- Psychomotor retardation.
- Tremor.
- Generalized muscle weakness.
- Blurred vision or diplopia.
- Stupor or coma.
- Euphoria.
4. 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.
Treatment
Patients who are experiencing Inhalant Intoxication are primarily managed through supportive care, and the focus is primarily on dealing with the symptomatology. It is also important to note that most individuals experiencing acute intoxication after inhalant use are not likely to seek treatment.
Among individuals with Inhalant Intoxication who do seek emergency treatment, there is a higher likelihood of either severe intoxication or injuries resulting from the intoxicated state. Hydration and cardiorespiratory status are checked, and stabilizing the patient is prioritized.
No medication has been found to reverse the effects of inhalant intoxication, and hence individual symptoms must be addressed.
Long-term treatment may be considered in case of concurrent Inhalant Use Disorder or other comorbidities.ย
Differential Diagnosis
1. Inhalant exposure, without meeting the criteria for inhalant intoxication disorder: The individual intentionally or unintentionally inhaled substances, but the dose was insufficient for the diagnostic criteria for inhalant use disorder to be met.
2. Intoxication and other substance/medication-induced disorders from other substances, especially from sedating substances (e.g., alcohol, benzodiazepines, barbiturates): These disorders may have similar signs and symptoms, but the intoxication is attributable to other intoxicants that may be identified via a toxicology screen. Differentiating the source of the intoxication may involve discerning evidence of inhalant exposure as described for inhalant use disorder.
3. Other inhalant-related disorders: Episodes of inhalant intoxication do occur during, but are not identical with, other inhalant-related disorders. Those inhalant-related disorders are recognized by their respective diagnostic criteria: inhalant use disorder, inhalant induced neurocognitive disorder, inhalant-induced psychotic disorder, inhalant-induced depressive disorder, inhalant-induced anxiety disorder, and other inhalant-induced disorders.
4. Other toxic, metabolic, traumatic, neoplastic, or infectious disorders that impair brain function and cognition: Various neurological and other medical conditions may produce clinically significant behavioral or psychological changes that also justify inhalant intoxication.
Specialist
Not all individuals who experience Inhalant Intoxication will seek treatment, and those who do are most likely to approach emergency settings.
Physicians may be responsible for stabilizing the patient and providing acute treatment, and they may be referred to psychiatrists, clinical psychologists, or rehabilitation therapists on the basis of a complete or partial diagnosis and potential comorbidities.
