Inhalant-related disorders — structured clinical viva

This is a dual-presentation addiction-toxicology viva: remote petrol sniffing with collapse under exertion (sudden sniffing death pathway teaching) plus urban N2O neurological complication. Family demand for permanent detention is a least-restrictive-care and culturally safe engagement test — not automatic indefinite lock-up, but also not minimisation of lethal risk.^[2][3][7]

SSD teaching: hydrocarbons sensitize myocardium; catecholamine surge with chase/exertion can trigger fatal arrhythmia — ECG/monitoring, medical clearance, honest risk counselling including first-use death possibility.^[2][3]

Pharmacotherapy vacuum: Cochrane — no eligible RCTs for licensed anti-craving/substitution for inhalant dependence; MacLean — psychosocial multi-component care; Nguyen — youth systems (family, school, community, dual diagnosis). In remote contexts, pair clinical care with community-controlled services and supply-reduction strategies (e.g. low-aromatic fuel programmes where used), avoiding deficit-only framing.^[5][6][7]

N2O arm: stop use; functional B12 pathway (MMA/homocysteine); early parenteral B12; neurology/rehab; do not dismiss numbness as "anxiety from depression admission."^[4]

Comorbidity: adolescent IUD samples are multi-problem — screen trauma, mood, other SUD, suicide.^[8]

Legal status: capacity and risk; jurisdiction-appropriate least-restrictive options if acute danger — do not invent section numbers. ^[1][7]