Toluene induced hypokalaemia: case report and literature review

Baskerville, Jerry Ray

doi:10.1136/emj.18.6.514

Cited by 26 publications

(8 citation statements)

References 15 publications

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“…The most common clinical presentation was muscular weakness due to hypokalemia (hypokalemic paralysis), a finding supported by previous reports (Streicher et al, 1981;Meadows & Verghese, 1996;Baskerville et al, 2001). Paralysis is the most life-threatening complication, and can lead to respiratory depression, as in one of our patients.…”

Section: Discussionsupporting

confidence: 87%

Clinical presentation and management in acute toluene intoxication: a case series

Cámara-Lemarroy¹,

Gónzalez-Moreno²,

Rodríguez-Gutiérrez³

et al. 2012

Inhalation Toxicology

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Section: Discussionsupporting

confidence: 87%

Clinical presentation and management in acute toluene intoxication: a case series

Cámara-Lemarroy¹,

Gónzalez-Moreno²,

Rodríguez-Gutiérrez³

et al. 2012

Inhalation Toxicology

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“…The most common clinical presentation in acute toluene intoxication was muscular weakness due to hypokalemia (hypokalemic paralysis, a life-threatening complication that can lead to respiratory depression), a finding supported by previous reports [ 6 , 12 , 36 , 45 ]. In contrast to the previous retrospective case series [ 12 ], we observed an alarmingly high mortality rate (15 %), and considering we gathered a similar number of patients over only 22 months, the incidence of acute toluene intoxication appears to be higher than previously recognized.…”

Section: Discussionsupporting

confidence: 73%

Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

et al. 2015

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BackgroundToluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication.MethodsWe prospectively assessed 20 patients that were admitted to a single center’s emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication.ResultsThe main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80 % of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities.ConclusionThe hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.

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“…Chronic toluene exposure can cause metabolic acidosis with an anion gap due to impaired renal excretion of the main metabolite of toluene, hippuric acid. Moreover, increased PAC due to volume contraction may play a role .…”

Section: Steroidogenesis Disorders Associated With Hypokalaemiamentioning

confidence: 99%

Current views on the diagnosis and management of hypokalaemia in children

2016

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Toluene induced hypokalaemia: case report and literature review

Abstract: Generalised weakness is a common complaint. A case is presented of toluene induced hypokalaemia in a 22 year old woman who presented with generalised weakness. The eVect of toluene and causes of weakness and hypokalaemia in this setting are discussed. (Emerg Med J 2001;18:514-516)

Cited by 26 publications

References 15 publications

Clinical presentation and management in acute toluene intoxication: a case series

Clinical presentation and management in acute toluene intoxication: a case series

Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

Current views on the diagnosis and management of hypokalaemia in children

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