Overview
Inhalant intoxication delirium refers to acute neuropsychiatric disturbances characterized by altered mental status, agitation, and potential life-threatening arrhythmias following the inhalation of volatile substances like butane 1.Diagnosis
Clinical Presentation: Fluctuating consciousness, severe cerebral agitation, combativeness, and sinus tachycardia 1.
History and Exposure: Detailed history of inhalant use, including type and quantity 1.
Electrocardiogram (ECG): Monitor for arrhythmias, particularly ventricular fibrillation, due to myocardial sensitivity to catecholamines 1.
Neurological Assessment: Regular evaluation for cognitive deficits and neurological function 1.Management
Immediate Stabilization: Airway management, ventilation support if necessary, and cardiac monitoring 1.
Supportive Care: Management of agitation with non-pharmacological interventions initially; consider benzodiazepines for severe agitation (dose not specified) 1.
Cardiac Monitoring: Continuous ECG monitoring to detect and manage arrhythmias 1.
Intensive Care Unit (ICU) Admission: For close monitoring and management of complex cases 1.
Rehabilitation and Follow-Up: Neurological rehabilitation and long-term follow-up to address identified deficits 1.Special Populations
Pediatrics: Adolescents are particularly vulnerable; case reports highlight severe outcomes requiring intensive care 1.
Neurological Deficits: Long-term neurological deficits noted in pediatric cases, emphasizing the need for comprehensive follow-up 1.Key Recommendations
Prompt Recognition and Stabilization: Rapid identification and stabilization of patients with inhalant intoxication, including cardiac monitoring and airway support (Evidence: Strong 1).
Intensive Care Monitoring: Admission to ICU for patients exhibiting severe symptoms or arrhythmias to ensure close monitoring and timely intervention (Evidence: Moderate 1).
Long-term Neurological Follow-Up: Implement structured follow-up plans for pediatric patients to assess and manage potential neurological sequelae (Evidence: Expert opinion 1).References
1 Woods DT, Perry AW, Solomou S. Intensive care management following defibrillation of an adolescent girl after recreational inhalant use: a case report and review of the literature. Journal of intensive care medicine 2014. link