Inhaled solvents
Drugs of abuse
Drugs of abuse
Glues, thinners, fuels and aerosols whose vapours are inhaled, mostly by adolescents. One session can trigger a fatal arrhythmia («sudden sniffing death»).
Also called: Inhalants, Volatile solvents (toluene, xylene, gasoline, thinner), Aerosols and gases
Quick facts
- Group
- Drugs of abuse
- Target
- NMDA and GABA-A receptors and other ion channels (anaesthetic-like actions)
- Used for
- No medical use · Clinical relevance
- Key effects
- Dizziness · Nausea and vomiting
- Monitor
- Continuous ECG · Arterial gases
No doses: the clinician sets them by the current guideline.
Mechanism of action
Volatile hydrocarbons such as toluene dissolve into nerve membranes and act like general anaesthetics: they inhibit NMDA receptors and enhance GABA function, with effects on other receptors and voltage-gated channels. The result is brief euphoria and disinhibition, then CNS depression, confusion, ataxia, and at high exposure coma and seizures. They also sensitise the heart muscle to adrenaline, so a sudden surge (fright, exertion) can trigger ventricular fibrillation.
- Solvent vapour is inhaled and reaches the brain quickly
- NMDA inhibition and stronger GABA signalling
- Euphoria, then confusion, ataxia, coma
- Myocardium sensitised to adrenaline: risk of ventricular fibrillation
Indications
- No medical use (nitrous oxide is a separate anaesthetic gas)
- Clinical relevance: hydrocarbon poisoning by inhalation or ingestion Hydrocarbon ingestion and aspiration →
Adverse effects
Common
- Dizziness, headache, slurred speech and blurred vision
- Nausea and vomiting
- Euphoria and disinhibition followed by drowsiness
- Solvent smell on breath, skin or clothes; skin irritation
Contraindications
- No medical use: any recreational exposure is dangerous
- Catecholamines (adrenaline, noradrenaline, dopamine, dobutamine) are avoided in solvent-induced arrhythmias
Key interactions
- Adrenaline and other catecholamines; sudden fright or exertion
- Ventricular arrhythmias in the sensitised heart
- Methanol used to adulterate thinner
- Added methanol poisoning with metabolic acidosis and blurred vision
- Alcohol and sedatives
- Deeper CNS and respiratory depression
What is monitored
- Continuous ECG, oxygen saturation, heart rate and blood pressure
- Arterial gases, potassium, chloride, kidney and liver tests
- Chest X-ray if there was ingestion, cough or hypoxaemia
- Level of consciousness and breathing pattern
Administration and safety
- Staff wear gloves and a mask; contaminated clothing is removed and the skin washed with soap and water
- After ingestion, vomiting is not induced and gastric lavage and activated charcoal are not used (aspiration risk)
- Arrhythmias are treated with lidocaine or a beta-blocker, not catecholamines
Pregnancy and breastfeeding
Use in pregnancy is linked to low birth weight, slow growth, hearing loss and developmental delay in the infant.
Nursing care
- Keep the patient calm and avoid startling them (adrenaline surge)
- Monitor the cardiac rhythm continuously
- Treat agitation or seizures with benzodiazepines as ordered
- Assess for suicide risk and refer to mental health and social support, especially in adolescents
Pharmacokinetics
- Absorption
- Inhalation is the usual route; aromatic hydrocarbons are well absorbed through the lungs
- Distribution
- Very lipid-soluble: fast entry into the brain
- Onset and duration
- Effects start quickly and are short-lived
Test yourself
Think of the answer, then tap the question to see it.
What is «sudden sniffing death»?
A fatal ventricular arrhythmia after solvent inhalation, because the solvent sensitises the heart to adrenaline.
Which drugs are avoided for solvent-induced arrhythmias, and what is used instead?
Catecholamines (adrenaline, noradrenaline, dopamine, dobutamine) are avoided; lidocaine or a beta-blocker is used.
Which kidney problem is typical of chronic toluene abuse?
Distal renal tubular acidosis with hypokalaemia and muscle weakness.
Why is activated charcoal not given after hydrocarbon ingestion?
It does not help and increases the risk of vomiting and aspiration pneumonitis.
Connections
← Back to the class: Drugs of abuse
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Guía para el Manejo de Emergencias Toxicológicas (Ministerio de Salud y Protección Social; Organización Panamericana de la Salud, 2017); Inhalants (National Institute on Drug Abuse (NIDA), 2024); Drugs A to Z (National Institute on Drug Abuse (NIDA), 2025).
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Representative model, for educational purposes only.