Causes and mechanism of action
The substances used include a wide variety of chemical compounds: gasoline, acetone, toluene, dichloroethane, nitrous oxide. Adolescents often use common household solvents, stain removers, glues, and air fresheners, so the exact composition of the inhaled mixture is usually unknown.
The greatest danger is posed by aromatic (e.g., benzene and toluene) and halogen-containing (dichloroethane, chloroethyl) compounds, as they break down in the body into highly toxic metabolites. The exact mechanism of their action on the nervous system has not yet been established, but it is hypothesized that they significantly affect the GABAergic system, which explains the similarity of symptoms to alcohol or sedative intoxication.
Clinical picture of intoxication
Toxicomanics usually inhale vapors from a soaked cloth or paper placed inside a bag. If the bag is placed entirely over the head, there is a critical risk of suffocation (asphyxia). Intoxication occurs ultra-fast — literally after a few breaths ("the rush").
Initial signs include:
- Dizziness and tinnitus.
- Lacrimation and increased salivation (hypersalivation).
This is followed by a picture resembling alcohol intoxication: lethargy, impaired motor coordination, slurred speech (dysarthria), double vision (diplopia), dilated pupils (mydriasis), and rapid heartbeat. If the concentration of inhaled vapors continues to rise, the person experiences illusions, a sense of unreality (derealization), and kaleidoscopic hallucinations.
When inhalation stops, consciousness returns quickly, but a post-intoxication syndrome ensues: head heaviness and pain, nausea, dizziness, and possible vomiting.
Dependence and withdrawal syndrome
Full-blown dependence does not develop in all users. Many are deterred by unpleasant sensations, fear, and severe consequences of poisoning.
If dependence has formed, a withdrawal syndrome develops upon attempting to stop use. Its main manifestations include:
- Irritability and sleep disturbances.
- Digestive problems (dyspepsia).
- Severe sweating (hyperhidrosis) and rapid heartbeat.
- Blood pressure fluctuations.
- In some cases — tremors and muscle twitching.
Consequences and prognosis
Long-term use of volatile solvents leads to catastrophic consequences for the entire body (multiorgan failure) and psyche. The prognosis for such patients is extremely unfavorable.
Mental disorders:
- In the early stages (while still reversible), the ability to learn drops sharply, and memory and attention deteriorate.
- In the late stages, persistent cognitive impairment develops, leading to dementia. Signs of dementia can be detected as early as the third year of regular inhalation.
Somatic disorders:
- Respiratory system: chronic pharyngitis and bronchitis.
- Heart: rhythm disturbances (arrhythmias).
- Liver: fatty liver disease progressing to cirrhosis.
- Kidneys: glomerular damage (glomerulonephropathy) and stone formation (nephrolithiasis).
- Blood and immunity: severe immune dysregulation, high risk of developing acute myeloid leukemia.
Mortality among substance abusers is high due to accidental overdoses and asphyxia. Many of those who survive eventually transition to harder psychoactive substances.
Principles of treatment
There are no specific antidotes or treatment methods for volatile solvent dependence. Therapy is based on the general principles of treating substance use disorders.
An critically important stage is the early administration of vitamins and nootropic drugs. This is necessary to at least partially restore cognitive functions and prevent the rapid development of dementia.
Briefly: answers to topical questions
What stages of acute volatile solvent intoxication are distinguished in clinical narcology?
The clinical picture of acute volatile solvent intoxication features several successive stages of symptom development.
- Initial symptoms — head noise, dizziness, lacrimation, and salivation.
- Alcohol-like symptoms — lethargy, impaired coordination, slowed reactions, reduced concentration, dysarthria, diplopia, mydriasis, and tachycardia.
- With increasing concentration — illusory and derealization experiences join in, turning into kaleidoscopic hallucinations.
- Post-intoxication syndrome — headache, head heaviness, nausea, and vomiting upon cessation of inhalation.
Which pharmacological groups of drugs are used to manage acute psychosis in inhalant intoxication?
To manage acute psychosis and psychomotor agitation during inhalant intoxication, general therapy principles are applied, including two main pharmacological groups.
- Tranquilizers — for example, diazepam.
- Antipsychotics — for example, haloperidol.
At the same time, the use of antipsychotics with pronounced anticholinergic activity (chlorpromazine, clozapine, thioridazine) is strictly contraindicated due to the risk of potentiating psychosis. Specific therapy for this group of substances is absent.
What specific changes are detected on brain MRI in chronic toluene encephalopathy?
Sources do not detail the specific MRI picture of chronic toluene encephalopathy specifically. It is only indicated that toluene is an organic solvent that causes toxic encephalopathy.
Class and exam questions
Why does intoxication from volatile solvents occur so rapidly?
Volatile substance vapors are absorbed through the massive surface area of the lungs and instantly enter the bloodstream, reaching the brain after just 3–5 breaths.
Which chemical substances are most dangerous when inhaled?
The greatest threat is posed by aromatic (benzene, toluene) and halogen-containing (dichloroethane) compounds because they convert in the body into extremely toxic metabolites.
What happens to intelligence in chronic substance abuse?
There is a persistent decline in cognitive functions. With regular use, signs of dementia develop as early as the third year.
Is there a specific medication for solvent addiction?
There is no specific therapy. Treatment is carried out according to general principles, with a mandatory emphasis on nootropics and vitamins to protect the brain.
What else to study on this topic
- General principles of treatment for narcotic intoxication and psychoses
- Management of anticholinergic delirium
- Mechanism of action and pharmacology of sedatives
- Symptoms of sedative intoxication and palimpsests
- Management of sedative withdrawal syndrome
- Pathogenesis and effects of tobacco smoking (nicotinism)
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