Toluene, the main component of volatile glues,
lacquer thinners and aerosol paints is the chemical
responsible for most clinical toxicity.
Inhalants cause an initial excitatory response
through the release of epinephrine and activation of
the dopamine system, followed by central nervous
system depression mediated by the use of GABA
as a sense of euphoria, excitation, dizziness,
disinhibited behaviour and exhilaration similar to
alcohol intoxication, thus resulting in psychological
Repeated inhalations by the user to
prolong the intoxication will develop in headache,
slurred speech, diplopia, gait abnormality, delusions,
visual hallucinations and disorientation.
Behavioural changes and characteristic
odour on breath or clothing are helpful clues to
detect cases. Suspected users may also complain
of cough, stuffy nose, sneezing, flushing, salivation,
nausea, vomiting and photophobia.
Other signs and symptoms of inhalant abuse
include spots or sores in or around the mouth,
injected sclera, nystagmus, irritability or excitability,
anxiety and sleep disturbances. Paint or other stains
on the face, hands, or clothes are other indicators
of abuse. Severe dryness of facial skin and mucus
membranes can also be a feature of repeated,
prolonged use of volatile substances8
infection of the dry and cracked skin may result
in perioral and perinasal pyodermas, sometimes
referred to as “huffer’s rash”9
Gait problems raises suspicion for alcohol abuse or inhaled glue. However, onset of gait problems is relatively rapid (couple of months) and gait disturbance with regards to alcohol is either due to intoxication or chronic abuse. Alternative explanation available on SDN. Also see toluene toxicity on medscape.
Inhaled glue is more likely than alcohol b/c of its ease of access for a minor and relative abuse potential in the age group.