Toluene

CAS RN:108-88-3

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Mild to moderate toxicity only requires supportive care, skin decontamination and removal from exposure. For inhalational exposures, patients should be moved to fresh air and respiratory treatments treated symptomatically (eg, patients with bronchospasm should be treated with beta-2 agonists). Hypokalemia should be treated with supplemental potassium. With fluid resuscitation and electrolyte replenishment, hypocalcemia may develop.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) There is no specific antidote, but good symptomatic and supportive care should be sufficient for most patients. Treat hypokalemia with supplemental oral and intravenous potassium; large quantities are often required as patients continue to have urinary potassium wasting for several days as renal tubular acidosis resolves. Cardiac dysrhythmias should be treated by correction of electrolyte abnormalities (primarily hypokalemia) and standard ACLS protocols, and severe respiratory distress/failure may require intubation. It has been suggested that adrenergic medications may worsen dysrhythmias; the evidence for this is limited, but they should be avoided, if possible. Animal studies have suggested that exogenous surfactant may improve lung function following hydrocarbon aspiration.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Gastrointestinal (GI) decontamination is not recommended because of the risk of CNS depression and subsequent aspiration. Irrigate exposed eyes with water, remove contaminated clothing, and wash exposed skin with soap and water.
    • 2) HOSPITAL: GI decontamination is not recommended because of the risk of CNS depression and subsequent aspiration. Irrigate exposed eyes with water, remove contaminated clothing, and wash exposed skin with soap and water.
  • D) AIRWAY MANAGEMENT
    • 1) If a patient has severe respiratory depression or distress, intubation may be necessary, but it is rarely necessary.
  • E) ANTIDOTE
    • 1) There is no specific antidote for toluene toxicity.
  • F) ENHANCED ELIMINATION
    • 1) There is no role for dialysis, hemoperfusion, urinary alkalinization, or multiple dose charcoal.
  • G) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Patients with inadvertent exposure who are asymptomatic may be managed at home.
    • 2) OBSERVATION CRITERIA: Symptomatic patients or patients with self-harm or deliberate abuse exposures should be sent to a healthcare facility for evaluation and observation.
    • 3) ADMISSION CRITERIA: Patients with continuous symptoms despite removal from exposure after several (4 to
    • 6) hours, and patients with significant acidosis and/or hypokalemia, should be admitted to the hospital, and depending on the severity of their symptoms, may merit an ICU admission. Patients with a history or findings suggesting aspiration (such as coughing, hypoxia or infiltrates) should be admitted for monitoring. Criteria for hospital discharge should be resolution of the patient's symptoms and laboratory abnormalities.
    • 4) CONSULT CRITERIA: If there is an environmental exposure, a Hazmat evaluation of the site may be mandated. Consult a medical toxicologist or poison center for patients with significant toxicity or in whom the diagnosis is unclear.
  • H) PITFALLS
    • 1) All catecholamines should be used with caution because of the reported enhanced risk of cardiac dysrhythmias. If there is an environmental exposure, a Hazmat evaluation may be required for the site. Many products that are abused for their toluene content also contain methanol, and deliberate inhalation of these products can cause significant methanol absorption. Patients who develop renal tubular acidosis (RTA) require large quantities of potassium supplementation, as total body potassium may be very depleted, and renal potassium wasting continues for several days after exposure ceases as the RTA resolves.
  • I) TOXICOKINETICS
    • 1) Toluene is most widely abused via inhalation and has a half-life of approximately 20 minutes, though its half-life in the serum is far more prolonged (13 to 68 hours). It is rapidly and well absorbed both via inhalation and orally. It is highly protein bound (approximately 95%) and widely distributed to adipose tissue.
  • J) DIFFERENTIAL DIAGNOSIS
    • 1) The differential diagnosis of toluene toxicity includes other causes of altered mental status, including trauma and infections, as well as other intoxicating substances, including ethanol, opioids, or other hydrocarbons.
0.4.3 INHALATION EXPOSURE
  • A) This is the most common form of exposure secondary to abuse. Patients should be moved to fresh air and associated symptoms treated in a supportive manner. Lung injury is rare following inhalational exposure unless there is ingestion with aspiration.
0.4.4 EYE EXPOSURE
  • A) Irrigate eyes with copious amounts of room temperature water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persists, the patient should seek further medical care.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) Dermal exposure should be treated with decontamination (removal of contaminated clothing and washing of exposed areas with soap and water).
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Find more information on this substance at: Hazardous Substances Data Bank , TOXMAP , TOXNET , PubMed