Toluene Poisoning - Diagnosis and Management Summary

What is it?  Volatile hydrocarbon, Glue or paint-sniffing, Occupational exposures, Highly lipid-soluble, Toxicity acute or chronic

Clinical presentation

Acute: CNS depression

Chronic: dRTA, CNS effects (inc psych)

Renal - acute:

 • Early raised AG acidosis (uncommon)

    - Hippurate well cleared

    - Usually associated with AKI

 • Late: normal anion gap acidosis, ↓K+

Renal - chronic:

 • Marked hypokalaemia typical

 • May present as periodic paralysis

 • Distal-RTA phenotype (but no nephrocalcinosis)

 • Urine ammonium may be ↑ or ↓

Treatment:

 • Can be challenging

 • HDU environment

 • Potassium replacement priority

 • Nb Bicarbonate can precipitate ↓K+

 • Withdrawal of exposure



Dr. John Booth @ThePeanutKidney



#Toluene #Poisoning #Toxicology #Diagnosis #Management #Treatment