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Complete blood count (CBC): CBC is useful as a routine screening laboratory test. Chronic users may exhibit bone marrow suppression, thrombocytopenia, and aplastic anemia.
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Chest radiograph: This study helps identify the etiology of respiratory difficulties associated with inhalant abuse. These include pneumothorax, aspiration pneumonia, or chemical pneumonitis with patchy or diffuse infiltrates. Chronic abusers with subsequent cardiomegaly might exhibit enlarged heart size and pulmonary edema.
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Inhalants are volatile substances producing vapors that can be taken intentionally via the pulmonary route to produce a mind-altering
Once the patient is medically stable, a thorough psychiatric evaluation is required. This will enable clinicians to establish a diagnosis while screening for comorbid psychiatric illness, given that 70% of persons who abuse inhalants meet criteria for at least one lifetime mood (48%), anxiety (36%), or personality (45%) disorder (7).
Differential diagnoses include intoxication with other substances (e.g., alcohol, cannabis, salicylates, opioids, benzodiazepines, barbiturates, nonbenzodiazepine sleep medications, carbon monoxide, and cyanide) that can cause CNS depression. Metabolic disturbances such as hypoglycemia, as well as misuse of medications such as metformin and isoniazid, should be ruled out.
TABLE 1. Street Terminology and Common Laboratory/Diagnostic Tests for Inhalant Abuse
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Recent efforts aimed at analyzing new forms of substance abuse have led to identification of risks associated with electronic cigarettes (1) and synthetic cannabinoids (2). Additionally, guidelines pertaining to low-risk cannabis use have been established (3). However, less focus has been placed on the forgotten but commonplace use of readily available inhalants as a means of achieving a “high” and its relationship with comorbid mental disorders.
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Clinicians should maintain a high index of suspicion for inhalant abuse when encountering young, intoxicated patients with relatively normal medical and laboratory workup, negative urine drug screen, and negative alcohol screen. However, clinicians should understand the limitations associated with making the diagnosis of inhalant use disorder, including lack of readily available diagnostic laboratory tests. Screening for comorbid psychiatric illness should be prompt, along with treatment interventions. In summary, inhalant abuse remains a dangerous behavior among young adults and warrants the label of a “wolf in sheep’s clothing” due to easy access to commonplace household items used as a form of substance abuse.
The patient’s name and other identifying details in the above case have been changed to protect the patient’s privacy.
Standard five- and seven-panel drug screens do not enable identification of inhalant abuse but should be used to rule out intoxication with other substances. An experimental study conducted in Sweden showed that inhaled 1,1,1,2-tetrafluoroethane, found in aerosol freezer sprays, resulted in a 0.002% postexposure urinary excretion of the inhaled amount, with an average half-life of only 58 minutes (10), suggesting that detection proves to be difficult even for just this one substance.
Inhalant Abuse: The Wolf in Sheep’s Clothing Recent efforts aimed at analyzing new forms of substance abuse have led to identification of risks associated with electronic cigarettes (1) and