Hydrocarbons

1. Hydrocarbons
1. Sniffing (from container) vs huffing (from a rag) vs bagging (breathing vapors in bags)
2. All hydrocarbons can cause sedation and inebriation; popular among underage teens who can buy these from department or hardware stores. There are thousands of hydrocarbon compounds, and many are mixtures (e.g. gasoline). Here are a few highlights and points of interest. 
3. Silver spraypaint allegedly gives the best high—picture a cachectic patient with silver hands and mouth.
4. Chlorinated hydrocarbons (chloral hydrate, trichloroethylene, methylene chloride, halothane) can cause SUDDEN SNIFFING DEATH. SSD occurs because myocardium becomes more sensitized to catecholaminesà sudden VF results when patient is suddenly excited. The key to treating this condition is to use beta-blockers to block the effects of adrenergic stimulation, even in cases of VF/Vtach/torsades.
5. Toluene: acutely converted to hippuric acid (wide anion gap acidosis) but chronic abuse causes renal tubular acidosis (a nongap acidosis) with low potassium. Weakness in a "glue-sniffer"/inhalant abuser is RTA-associated hypokalemia until proven otherwise. Chronic toluene abuse can also cause cerebellar atrophy and cerebral leukoencephalopathy (white matter degeneration) which are permanent.
6. Aspiration of hydrocarbons into the lung causes breakdown of surfactant and alveolar collapse (HYDROCARBON PNEUMONITIS). Lowgrade fevers, infiltrates and hypoxia expected to occur as early as the first few hours (this is not an infection). Compunds with low viscosity (not thick like maple syrup) and high volatility (easily vaporized) are most likely to cause pneumonitis.
7.  In kids with hydrocarbon accidental ingestion, the recommendation is to observe for 6 hrs and get a 6-hr film and oxygen saturation to r/o aspiration pneumonitis. Coughing and gagging immediately upon ingestion heralds a poor prognosis.
8. Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly known as “poppers.” Amyl nitrite is still used in certain diagnostic medical procedures. When marketed for illicit use, they are often sold in small brown bottles labeled as “video head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.” Nitrites can cause methemoglobinemia, weakness, hypotension/syncope.
   
   
9. Chloral hydrate—a highly sedating hydrocarbon. It classically smells like pears. Used in pediatrics for procedures. Inhibits metabolism of ethanol, and ethanol inhibits chloral hydrate metabolism (this combination is the notorious "Mickey Finn"). Sudden cardiac death can occur (see part d above) due to catecholamine sensitization. Torsades de pointes is  also possible via the same mechanism. Chloral hydrate is also radioopaque—KUB xray can show an air-on-fluid-on- fluid level. Also very irritating to the GI tract—burns the mucosal membranes.
10. Methylene Chloride (CH2Cl2) is found in in paint strippers. Liver will convert this compound into carbon monoxide within 8-12 hrs. Watch for delayed CO toxicity.