Psych · Addiction psychiatry — inhalant-related disorders
Inhalant-related disorders
Also known as Volatile substance misuse · VSM · Chroming · Solvent abuse · Petrol sniffing · Glue sniffing · Huffing · Sudden sniffing death · Nitrous oxide misuse · Whippets · Inhalant use disorder
Fellowship-depth atlas on inhalant-related disorders — volatile solvent, aerosol and hydrocarbon gas misuse (including petrol sniffing and chroming), sudden sniffing death, chronic toluene neurotoxicity, recreational nitrous oxide myeloneuropathy, adolescent epidemiology, psychosocial care, and the absence of licensed anti-craving pharmacotherapy. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Syncope, chest pain, seizure or collapse during or immediately after hydrocarbon use — treat as possible sudden sniffing death pathway (arrhythmia); ECG and monitoring
- Agitated or comatose intoxication with chemical odour — ABC first; exclude aspiration, burns, hypoxia and trauma
- Subacute gait ataxia, paraesthesia or proprioceptive loss after recreational nitrous oxide — stop use; check B12/MMA/homocysteine; start parenteral B12 and neurology pathway
- Solitary bagging/chroming in enclosed spaces — asphyxia and sudden death risk; do not leave unsupervised while intoxicated
- Active suicidal ideation in adolescent inhalant users with high comorbidity — same-day risk plan and collateral
- Persistent cognitive decline after chronic toluene exposure — dual formulate white-matter injury vs primary psychosis; do not force a single label on day one
Meet the patient
A 15-year-old is brought to the ED unconscious after collapsing in a park. His friends ran. He smells of aerosol propellant, has a perioral rash, and an empty deodorant canister lies beside him. He was running from a security guard when he dropped.[2][4]
Three questions now decide whether he leaves the department alive: is this a sedative overdose or a cardiac arrest pathway? and what was he doing in the seconds before he collapsed? and who is waiting for him at home? This topic answers all three at consultant depth.[2][14]
References14ShowHide
- [1]Howard MO, Bowen SE, Garland EL, et al. Inhalant use and inhalant use disorders in the United States Addict Sci Clin Pract, 2011.PMID 22003419
- [2]Bass M Sudden sniffing death JAMA, 1970.PMID 5467774
- [3]Bowen SE Two serious and challenging medical complications associated with volatile substance misuse: sudden sniffing death and fetal solvent syndrome Subst Use Misuse, 2011.PMID 21609149
- [4]Berling I, Isbister GK Rare but relevant: Hydrocarbons and sudden sniffing syndrome Addiction, 2025.PMID 40275758
- [5]Yücel M, Takagi M, Walterfang M, Lubman DI Toluene misuse and long-term harms: a systematic review of the neuropsychological and neuroimaging literature Neurosci Biobehav Rev, 2008.PMID 18456329
- [6]Cruz SL, Rivera-García MT, Woodward JJ Review of toluene action: clinical evidence, animal studies and molecular targets J Drug Alcohol Res, 2014.PMID 25360325
- [7]Shaw AA, Steketee JD, Bukiya AN, et al. Toluene Toxicity in the Brain: From Cellular Targets to Molecular Mechanisms Annu Rev Pharmacol Toxicol, 2025.PMID 39847463
- [8]Swart G, Blair C, Lu Z, et al. Nitrous oxide-induced myeloneuropathy Eur J Neurol, 2021.PMID 34427020
- [9]Wu LT, Pilowsky DJ, Schlenger WE Inhalant abuse and dependence among adolescents in the United States J Am Acad Child Adolesc Psychiatry, 2004.PMID 15381887
- [10]Sakai JT, Hall SK, Mikulich-Gilbertson SK, Crowley TJ Inhalant use, abuse, and dependence among adolescent patients: commonly comorbid problems J Am Acad Child Adolesc Psychiatry, 2004.PMID 15322411
- [11]Perron BE, Howard MO Adolescent inhalant use, abuse and dependence Addiction, 2009.PMID 19426292
- [12]Konghom S, Verachai V, Srisurapanont M, et al. Treatment for inhalant dependence and abuse Cochrane Database Syst Rev, 2010.PMID 21154379
- [13]MacLean S, Cameron J, Harney A, Lee NK Psychosocial therapeutic interventions for volatile substance use: a systematic review Addiction, 2012.PMID 22248138
- [14]Nguyen J, O'Brien C, Schapp S Adolescent inhalant use prevention, assessment, and treatment: A literature synthesis Int J Drug Policy, 2016.PMID 26969125