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ACUTE EXPOSURE INFORMATION
- USES: Toluene (toluol, methyl benzene) is an aromatic petroleum hydrocarbon that has many commercial and industrial applications. It is used as a solvent and starting material for organic synthesis and is found in paints, paint thinners, glues, and other products. Toluene products are abused via inhalation for their intoxicating effects.
- TOXICOLOGY: It has long been held that toluene's effect on the central nervous system are via nonspecific lipophilic membrane interactions, which in turn modulates several neurotransmitter systems (ie, dopamine, acetylcholine, GABA, glycine, and serotonin).
- EPIDEMIOLOGY: Exposures are common, but significant toxicity is generally only seen in the setting of deliberate inhalation abuse and deaths are rare.
- WITH POISONING/EXPOSURE
- MILD TO MODERATE TOXICITY: Acute ingestion causes CNS depression, oropharyngeal and gastric pain and vomiting. Splash exposure to eyes may cause irritation, burning, blepharospasm, conjunctivitis, corneal edema, and corneal abrasions. Symptoms usually resolve within 48 hours. Prolonged or repeated dermal exposures may result in a defatting dermatitis. Occupational exposure has been linked to an increased risk of esophageal and rectal cancers as well as increased mortality from bone and connective tissue cancers.
- SEVERE TOXICITY: Acute inhalation produces a biphasic response with an initial CNS excitation followed by CNS depression, which is characterized by ataxia, fatigue, sedation, occasionally seizures, and at very high concentrations general anesthesia. Sudden death may occur from hypoxia or cardiac dysrhythmias. Chronic inhalational abuse is associated with muscular weakness, gastrointestinal symptoms (pain, nausea, vomiting), renal tubular acidosis (hypokalemia and metabolic acidosis), hepatic injury, and neuropsychiatric symptoms. Patients who chronically abuse toluene may exhibit hypokalemia, hematuria, proteinuria, oliguria, paresis, rhabdomyolysis, hallucinations, hyperactive reflexes, peripheral neuropathy, personality changes, tremors, headaches, emotional lability, and memory loss. Patients with long-term inhalational abuse may develop progressive irreversible encephalopathy with cognitive difficulty and cerebellar ataxia. Significant inhalational exposure causes an easily recognized odor to the breath that may persist for several days after exposure ceases. There are a small number of case reports of mothers who regularly abused toluene recreationally during pregnancy giving birth to children with microcephaly, CNS dysfunction, and minor head, face and limb anomalies. However, some of these mothers also abused ethanol as well.
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