Suspected Solvent Abuse in Cases Referred to the Poisons Unit, Guy's Hospital, July 1980-June 1981

Abstract

<jats:p> 1 From July 1980 to June 1981, requests for information as to management or prognosis were received concerning 324 patients (219 male, 91 female) aged 3-31 y (median 15 y) in whom 'solvent abuse' was suspected. </jats:p><jats:p> 2 The principal symptoms reported were unconsciousness (37), drowsiness (62), 'collapse' (7), convulsions (6), ataxia (35), chest pain (9), nausea/vomiting (20), renal impairment (3) and behavioural disturbances (84). At least 105 patients were admitted to hospital, and 1 was dead on arrival. </jats:p><jats:p> 3 The products abused in 290 clinically diagnosed cases were: adhesives (214), correcting fluids (23), chlorinated solvents (17), fuel gases (18), petrol (5), BCF fire extinguishing agent (5) and others (17). The co-ingestion of alcohol or other drugs was suspected in only 27 cases. </jats:p><jats:p> 4 Specimens of blood and/or urine were received for analysis from 117 patients. The clinical diagnosis of solvent abuse was confirmed in 71 cases and solvents were detected in 2 further instances. Ethanol/other drugs were detected in 18 instances, either together with solvent(s) (9) or alone (9), although no compounds were detected in the remaining 35 cases. </jats:p><jats:p> 5 Toluene (and/or raised urinary hippurate/creatinine ratio) was detected in 52 of the analyses, 1,1,1-trichloroethane in 14 and trichloroethylene (and/or trichloroethanol) in 12. Ethanol was detected in 7 instances, and other drugs (principally benzodiazepines) in 13. </jats:p><jats:p> 6 Although the presenting symptoms and outcome were usually unremarkable, these results emphasise that some patients can develop serious illness such as collapse or convulsions, which may prove fatal, while chronic solvent abuse can be associated with renal impairment. </jats:p>

Volatile Substance Abuse: A Review of Possible Long-Term Neurological, Intellectual and Psychiatric Sequelae

“…Thus, in a group of 20 consecutive admissions reported by King (1982), coma was the presenting feature in five of them, epileptic con vulsions in three, dysarthria in five, and ataxia in the rest. These findings are in agreement with those of Francis et a! (1982) from the National Poisons Information Service, who received requests for information on 105 patients admitted to different hospitals in the UK.…”

“…(1982) from the National Poisons Information Service, who received requests for information on 105 patients admitted to different hospitals in the UK. Impairment of consciousness appears to be quickly reversible in most cases (Streicher et a!, 1981;King, 1982), and only 19% of the 105 admissions reported by Francis et a! (1982) remained in hospital for more than 24 hours.…”

“…These declared preferences have been confirmed by analysis of blood and urine samples during acute intoxication. Oliver & Watson (1977) detected toluene and acetone in 84% of 42 consecutive cases, and Francis et a! (1982) found toluene in 73% of the samples received at the The pattern of VS abuse associated with fatalities is different, however.…”

An Investigation of 140 Deaths Associated with Volatile Substance Abuse in the United Kingdom (1971-1981)

“…Anecdotal evidence, incident reporting, and referrals to the Guy's Poisons Unit (Francis et al, 1982) all indicate that solvents in adhesives are the most widely used, and yet these account for only a small proportion of deaths, especially when death not directly due to the solvent are excluded. Our evidence therefore lends support to assertions (Release, 1981) that toluene inhalation carries less risk of sudden death; nevertheless it is clear that sudden death does occur as a result of toluene inhalation and that this practice is potentially dangerous.…”

Successful out-of-hospital defibrillation for ventricular fibrillation complicating solvent abuse.

“…Against this level of extent of solvent abuse the number of cases admitted to hospital is relatively few. In one year the Guy's Hospital Poisons Unit received 324 enquiries concerning patients in whom solvent abuse was suspected (Frances et al, 1982) and the Grampion data revealed only 21 cases in 1981 and 6 cases in 1982 reported by Accident & Emergency departments. Solvent abuse does not, therefore, generate a numerically large problem of morbidity and mortality.…”