Toluene toxicity metabolic acidosis. html>rn
Toxic ingestions. Therefore, intoxication with ethylene glycol should not be misdiagnosed as lactic acidosis in patients with metabolic acidosis and elevated lactate levels. The most common causes of a high anion gap metabolic acidosis are. Case Presentation: Here, we describe the case of a 45-year-old female patient with non-anion gap metabolic acidosis, hypokalemia, and alkaline urine. An osmolar gap of > 10-25 mOsm in the setting of high anion gap metabolic acidosis (anion gap > 12) is suggestive of toxic alcohol ingestion. M – M ethanol (formic acid), metformin. Severe AGMA due to alcoholic ketoacidosis (AKA) is often an Practice Essentials. The primary purpose of this chapter is to provide public health officials, physicians, toxicologists, and other interested individuals and groups with an overall perspective on the toxicology of toluene. 35-7. Email to a Friend Sep 26, 2022 · The differential diagnosis for toxic alcohol ingestion includes any cause of metabolic acidosis. Apr 14, 2023 · Metabolic acidosis happens when your blood becomes too acidic. Metabolic acidosis can develop if you have too many acids in your blood that wipe out bicarbonate (high anion gap metabolic acidosis) or if you lose too much bicarbonate in your blood as a result of kidney disease or kidney failure (normal anion gap metabolic acidosis). The acidosis caused by these toxins may sometimes present as a normal anion-gap hyperchloraemic Jul 24, 2023 · 2. , 4. Toluene sniffing, frequently described under the generic category of "glue sniffing A consequence of this is a toluene-induced renal tubular acidosis in some patients. In a previous case series, we retrospectively studied 22 cases of acute toluene toxicity and found that toluene inhalation is associated with various severe metabolic This work presents the case of a young woman who had a normal anion gap metabolic acidosis due to toluene sniffing and an unexpectedly low urine anions gap, and the challenges in interpretation of the urineAnion gap and ammonia excretion in the setting of distal renal tubular acidosisdue to toLUene toxicity. Exposure to hydrocarbons is common because these substances are readily found in products like kerosene, gasoline, household cleansers, furniture polish Nov 3, 2020 · R – R enal tubular acidosis types 1, 2, and 4. 1 RTA with hypokalemia can be seen in type 1 (distal) or type 2 (proximal) RTA Generalised weakness is a common complaint. Add to Favorites. Respiratory acidosis and alkalosis can also arise, commonly due to central stimulation or depression of ventilation. Toluene may also cause significant renal damage especially with chronic use. This can result from other health conditions, such as diabetes that isn’t effectively controlled and kidney disease, among others. Email to a Friend Context: Toluene inhalation is a common form of drug abuse throughout the world. Close attention is required to patients with severe metabolic acidosis, and though an anion gap is helpful in suspecting and making the diagnosis, the appearance of an anion gap depends on the timing of the alcohol ingestion. Jun 1, 2012 · Abstract. Oct 1, 2011 · Discussion. Kidney Damage: Oxalic acid, a metabolite of ethylene glycol, can combine with calcium to form insoluble crystals, leading to the formation of kidney stones . The osmolar gap and the anion gap are useful in diagnosing toxic alcohol ingestion. Box 2. On the other hand, the final product of toluene metabolism, hippuric acid can accumulate, elevating the anion gap and causing a high Anion gap Nov 3, 2020 · Ethanol level. 35 to 7. Metabolic acidosis is a clinical disturbance defined by a pH less than 7. According to Carlisle et al. Urine anion gap is used to diagnose metabolic acidosis Aug 18, 2015 · The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Lactic acidosis. Therefore, the hyperchloraemic metabolic acidosis secondary to renal tubular acidosis. U – U raemia (including aminoglycosides) R – R enal failure (Uric acid) K – K etoacidosis (alcohol, diabetes (acute), starvation) L – L actic acidosis. A thorough history and physical are valuable in narrowing the differential diagnosis, and the practitioner should inquire into the use of alcohol/drugs by the patient, as well as potential toxic ingestions or environmental exposures. the patient is unwell because they have accumulated H +, or an epiphenomenon reflecting the effects of the underlying process, or the accumulation a toxic aprote anion species. E – E thanol. Increased anion gap metabolic acidosis. Aug 18, 2015 · Acidosis itself has been proposed as a contributing factor in the development of rhabdomyolysis in hypokalemia [16, 26], but in vivo animal studies failed to show that either chronic or acute acidosis increases myoglobin renal toxicity . Typically asymptomatic presentations of neuromuscular weakness emerge at levels May 5, 2020 · Second, Fanconi syndrome may occur due to direct toxicity of toluene on proximal tubule and accompany distal RTA, mixed-type acid-base disorder. Common causes are often implied by the acronym, MUDPILES (methanol, uremia, diabetic ketoacidosis, paraldehyde, iron overdose, lactic acid, ethylene glycol and salicylate). While some disease processes and ingestions are easily excluded, diagnosing toxic alcohol (TA) ingestion can be challenging. 24). Halogenated hydrocarbon abuse can cause a fatal malignant arrhythmia, termed "sudden sniffing death". Toluene sniffing, frequently described under the generic category of "glue sniffing," is a potential cause of normal anion gap metabolic acidosis due to distal renal tubular acidosis. metabolic acidosis. 45), signifying severe metabolic acidosis. 7. 35. Feb 9, 2016 · Acid–base abnormalities are common in severely poisoned patients, particularly metabolic acidosis, which may be a major clinical effect of the overdose. Metabolic acidosis is a clinical disturbance characterized by an increase in plasma acidity. e. The osmolar gap and anion gap change over time: Jan 2, 2021 · 4. Patients with toluene toxicity may initially be suspected of having ethylene glycol toxicity especially as the presentation may be similar (eg a patient with mental obtundation, appearance of intoxication and a metabolic acidosis). May 25, 2023 · Isopropyl alcohol (isopropanol, 2-propanol, propan-2-ol) is commonly used as a disinfectant, hand sanitizer, antifreeze, and solvent, and typically comprises 70 percent of "rubbing alcohol. 35 ( Box 2 ). Aug 1, 2009 · Toluene Toxicity as a Cause of Elevated Anion Gap Metabolic Acidosis. 06 +/- 0. Toluene also causes an acidosis and the anion gap may be normal or elevated. 6 mEq/L and severe metabolic acidosis with total CO2 of 7 mmol/L and HCO3 15. Jun 14, 2024 · Signs and symptoms of metabolic acidosis are broad and are often a result of the underlying etiology of the metabolic acidosis. Rarely, both can result in death. Mar 20, 2023 · However, acute toluene toxicity affects all body organs and produces remarkable alterations such as metabolic acidosis, hypokalemic paralysis, rhabdomyolysis, and liver injury. Respir Care. Toluene sniffing, frequently described under the generic category of "glue sniffing," is a potential cause of normal anion gap metabolic acidosis due to distal renal tubular acidosis. 35) develops with an increase in ionic chloride. Conversion of other AG acidoses to hyperchloremic Context: Anion gap metabolic acidosis (AGMA) is common in patients presenting for emergency care. Toluene (methylbenzene, toluol, phenylmethane) is an aromatic hydrocarbon (C7 H8) commonly used as an industrial solvent for the manufacturing of paints, chemicals, pharmaceuticals, and rubber. The anion gap helps determine the cause of the metabolic acidosis. Toluene itself is not an acid but is rapidly metabolized to benzoic (benzyl) acid, which is then quickly converted to hippuric acid. ) This report presents the case of a patient whose inhalation exposure to benzyl alcohol led to clinical manifestations similar to toluene intoxication, including sudden altered mental status, metabolic acidosis, hypokalemia, hypophosphatemia, and hyperammonemia. Background: Distal renal tubular acidosis (dRTA) can be inherited or acquired. Dec 28, 2023 · bolic acidosis occurs in 87% of toluene intoxication cases, indicative of distal tubular acidosis. Her initial presentation mimicked hypokalaemic periodic paralysis, but Aug 18, 2015 · The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Hydrocarbons cause rapid CNS depression, seizures and rarely cardiac dysrhythmias. May 5, 2021 · In individuals with chronic kidney disease, toluene may present with an anion gap metabolic acidosis. The major pH buffer system in the human body is the bicarbonate Feb 1, 2005 · Abstract. Apr 20, 1979 · Toxic effects of toluene: a new cause of high anion gap metabolic acidosis Feb 1, 1988 · In 5 individuals addicted to toluene sniffing we documented the occurrence of hypokalemia and hyperchloremic metabolic acidosis associated with inability to lower urine pH below 5. Sep 8, 2023 · Salicylate (aspirin) poisoning: Clinical manifestations and evaluation; Serum anion gap in conditions other than metabolic acidosis; Simple and mixed acid-base disorders; Society guideline links: Acute kidney injury in adults; Society guideline links: Toxic alcohol poisoning; Strong ions and the analysis of acid-base disturbances (Stewart approach) Mar 1, 2005 · Chronic toluene inhalation causes a non-anion gap metabolic acidosis associated with hypokalemia. 6. Apr 11, 2022 · Next: Imaging Studies. 5 (6. 6 are distal renal tubular acidosis type 1 (RTA-1), classically described as hyperchloremic with a normal anion-gap, as well as hypokalemia and muscle paralysis [14]. Robert P Dickson, Andrew M Luks. ∗A low urine osmolal gap (<150 mOsmol/kg) implies ammonium To our knowledge, only one article has reported the association between toluene inhalation and metabolic acidosis, and the findings were consistent with distal renal tubular acidosis (RTA). Urine anion gap is used to diagnose metabolic acidosis of a normal anion gap variety; however, pitfalls exist when using urine anion gap in Feb 27, 2014 · Metabolic acidosis is perhaps the most common derangement in acid-base encountered in the ED. The cause of death was in all cases due to cardiac rhythm abnormalities. Toluene ingestion/inhalation—loss of Na(K) with hippurate and benzoate and retention of the protons: 3. (See Etiology, DDx, Workup, and Treatment . A 21-year-old woman developed severe muscle paralysis after sniffing toluene-containing thinner solution for 2 weeks. Benzyl alcohol is commonly used as a preservative in intravenous medications. 8 Metabolic acidosis in CKD. 20 Large ingestions of ethanol can produce metabolic acidosis due to its metabolism to acetic acid. Other toxins which can cause acidosis are isopropyl alcohol and butoxyethanol. Conclusion: The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Hypokalemic paralysis Apr 1, 2022 · Chronic toluene inhalation causes a non-anion gap metabolic acidosis associated with hypokalemia. Accumulation of hippuric acid and other organic acid byproducts of toluene metabolism is thought to be responsible for the elevated anion-gap metabolic acidosis that occurs with toluene abuse. Acute toluene toxicity causes neurological changes as well as various metabolic alterations. Hyperchloremic acidosis is a disease state where acidosis (pH less than 7. Therefore, toluene toxicity can have fatal consequences if proper preventive measures are not followed, and timely medical assistance is not provided to an exposed person. Treatment consists of K + and HCO −3 replacement. Important toxicological considerations for metabolic acidosis are salicylates, acetaminophen, iron, carbon monoxide, cyanide, alcoholic ketoacidosis, and ingestion of other alcohols, such as methanol, diethylene glycol, or toluene. Her electrolyte and acid-base status returned to normal 4 days after cessation of toluene sniffing. Abnormalities of the plasma potassium concentration are also common, due 8. Other serum chemistry tests revealed the following (Table 1): sodium Nov 3, 2020 · Hydrocarbon toxicity. A study in 1038 adults with non-dialysis CKD stages 2-5 showed that the prevalence of metabolic acidosis is 7% in CKD-2, 13% in CKD-3 and 40% in CKD-4/5 [57]. [ 1] Metabolic acidosis should be considered a sign of an underlying disease process. Identification of this underlying condition is essential to initiate appropriate therapy. Toluene mixes readily with many organic solvents, but is poorly soluble in water. It is generally defined as a plasma bicarbonate of less than 22 mmol/L and an acidemia with a pH lower than a normal value of 7. Toluene sniffing can also induce normal anion gap acidosis by hindering renal elimination of ammonium ions, the primary Toluene toxicity as a cause of elevated anion gap metabolic acidosis. It is flammable at temperatures greater than 40°F (4. Toluene inhalation is a common form of drug abuse throughout the world. Therefore, direct toluene muscular injury and electrolyte abnormalities appear to be the main causes of Jan 1, 2019 · A previously healthy 27-year-old man who presented with acute ascending paralysis, with an associated severe hypokalemia and metabolic acidosis is described, and an algorithmic approach incorporating urine biochemistries to aid in the workup of hypokAlemia is reviewed. Patients with CKD commonly develop NAG-MA with variable hyperkalemia once glomerular filtration rate (GFR) is < 20-25 ml/min. Toluene toxicity as a cause of elevated anion gap metabolic acidosis. In a review of cases of toluene abuse, metabolic acidosis was observed in 87% of patients. It is a metabolic disturbance producing an increase in [H +] or a decrease in [HCO 3− ]. On another occasion, apart from renal tubular acidosis, the patient also developed severe hypophosphataemia with the phosphate level decreasing to 0. Apr 6, 2022 · Metabolic acidosis is a common phenomenon in toluene abusers and is often associated with lactate accumulation and electrolyte abnormalities. Both forms can have considerable adverse Toluene Toxicity as a Cause of Elevated Anion Gap Metabolic Acidosis Robert P Dickson MD and Andrew M Luks MD Introduction Dyspnea and elevated anion gap metabolic acidosis are common presenting problems in critically ill patients. It contains descriptions and evaluations of toxicological studies and epidemiological investigations and provides conclusions, where possible, on the relevance of toxicity and toxicokinetic Nov 23, 2022 · What is metabolic acidosis? Metabolic acidosis is when acids build up in your body fluids. It is identified as CAS#108-88-3, and the United Nations Department of Transportation's number for toluene is UN#1294. The use of A life-threatening complication of toluene sniffing may be the induction of a renal tubular acidification defect, which seems to be primarily of the Type 1, distal tubular variety. " People ingest isopropyl alcohol either unintentionally or with the intent to become intoxicated (ie, ethanol substitute) or to harm themselves. Chronic toluene inhalation causes a non-anion gap metabolic acidosis associated with hypokalemia. A possible mechanism of sudden sniffing death related to toluene abuse is ventricular arrhythmias, yet the true mechanism is still unknown. Individuals who regularly abuse hydrocarbons are more likely to be polysubstance users, exhibit criminal or violent behavior, and develop memory Sep 7, 2011 · The initial diagnosis of ethylene glycol poisoning is difficult and poisoning with ethylene glycol is rare but life threatening and needs rapid recognition and early treatment. 45. [6] In the present case, the initial venous blood gas showed a pH of 6. Six of eight additional patients reported to have non-anion gap metabolic acidosis on presentation also had high urinary excretion of ammonium during acidosis, suggesting that distal RTA was not a factor in Nov 14, 2023 · Metabolic Acidosis: Ethylene glycol is metabolized in the body to toxic byproducts, such as glycolic acid and oxalic acid, which can lead to severe metabolic acidosis. Benzene is known to cause hematological disorders. Toluene sniffing can also induce normal anion gap acidosis by hindering renal elimination of ammonium ions, the primary Aug 18, 2015 · There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. 6 mmol/L. Methanol exposure can be extremely dangerous, with significant morbidity and mortality if left untreated. The high anion gap is probably a consequence of its metabolism to hippuric acid. Normal anion gap metabolic acidosis and potassium wasting could be caused by RTA, toluene toxicity, or diarrhea. Ketoacidosis is a common complication of type 1 diabetes mellitus (see diabetic ketoacidosis), but it also occurs with chronic alcohol use disorder (see alcoholic ketoacidosis), undernutrition, and, to a lesser degree, fasting. A decline in pH below this range is called acidosis, an increase in this range is known as alkalosis. Initial laboratory workup was notable for profound hypokalemia with a serum potassium level of 1. During recovery from ketoacidosis—loss of Na(K) with beta-hydroxybutyrate and acetoacetate: 2. The absence of metabolic acidosis and hypokalemia makes toluene poisoning unlikely. Toluene inhalation can result in multiple electrolyte and acid-base . May 30, 2012 · Context: Toluene inhalation is a common form of drug abuse throughout the world. 3 Hyperchloremic metabolic acidosis, hypokalemia and acute renal insufficiency due to extracellular volume concentration were salient presenting features. Jun 12, 2023 · Methanol (CH3OH) is a toxic alcohol that is found in various household and industrial agents. An elevated anion gap metabolic acidosis can be caused by salicylate toxicity, diabetic ketoacidosis, and uremia (MUDPILES). 1 Between 1975 and 1977, three toluene sniffers were admitted to Jackson Memorial Hospital, Miami, with severe acidemia. Jan 1, 2012 · Inhalation of toluene leads to a classic hyperproduction of metabolic acidosis because of the metabolism of toluene to hippuric acid, which is readily excreted by the kidney with Na +, K +, and NH +4 . Rationale: Hypokalemia is a common finding. Sep 8, 2023 · Salicylate (aspirin) poisoning: Clinical manifestations and evaluation; Serum anion gap in conditions other than metabolic acidosis; Simple and mixed acid-base disorders; Society guideline links: Acute kidney injury in adults; Society guideline links: Toxic alcohol poisoning; Strong ions and the analysis of acid-base disturbances (Stewart approach) Mar 10, 2008 · It is often unclear whether metabolic acidosis is a ‘primary’ abnormality, i. Aspiration causes a chemical pneumonitis and this risk is increased in those products that have the lowest viscosity. The effect of toluene and causes of weakness and hypokalaemia in this setting are discussed. Understanding the physiological pH buffering system is important. We will consider the impact that metabolic acidosis may have on prognosis, whether A temporal relation between the metabolic acidosis and toluene inhalation was consistently present in both patients, and high levels of toluene were demonstrated in their blood. Sep 3, 2019 · Abstract. A case is presented of toluene induced hypokalaemia in a 22 year old woman who presented with generalised weakness. A patient who presented with non-anion gap metabolic acidosis from toluene toxicity but had no demonstrable RTA has also been reported . Third, if hippuric acid accumulates in the plasma due to low GFR and/or high production rate that exceeds excretion rate, metabolic acidosis with high anion gap may be observed [3,4,5]. Toxicity from benzyl alcohol inhalation is quite rare, and hyperammonemia associated Dec 1, 2015 · Toluene abuse is associated with major toxicities including severe metabolic acidosis with lactate accumulation, CNS depression, ventricular arrhythmias, rhabdomyolysis, and liver toxicity. Increased excretion of hippuric acid in the form Apr 5, 2022 · Numerous drugs and toxins can cause metabolic acidosis. Elevated urinary concentration of retinol-binding protein has been correlated with toluene exposure in a dose-dependent manner, which suggests that early Nov 1, 2019 · Toluene intoxication has long been associated with the development of type 1 (distal) renal tubular acidosis (RTA), which causes a normal anion gap (AG) hyperchloremic metabolic acidosis and hypokalemia [3]. 15 mmol/L. Hypophosphataemia with such a low phosphate level after toluene poisoning has been rarely reported in the literature. Figure 2 Systematic approach to hypokalemia. Metabolic acidosis produced by drugs and/or chemicals can be conveniently divided into those with an increase in the anion gap (anion gap = Na- (Cl + HCO3)) and those with a normal anion gap. 8. Physical examina-tion revealed loss of muscle strength in the upper and lower extremities. P – P ancreatic fistula. One patient required several The most common causes of a high anion gap metabolic acidosis are. Objective: To identify the clinical and metabolic alterations associated with toluene intoxication. She had a history of rheumatoid arthritis and kidney stones and failed to acidify urine upon the fludrocortisone and furosemide test. Oct 1, 2011 · An index case is presented to introduce the subject of the acid-base and electrolyte abnormalities resulting from toluene abuse. INTRODUCTION: Anion gap metabolic acidosis (AGMA) is a common scenario in critically ill patients. The treating clinician should be aware of the many compounds that can produce metabolic acidosis following an accidental exposure, an overdose, or with therapeutic use. Ketoacidosis. Her serum chemistries revealed severe hypokalaemia and a normal anion gap hyperchloraemic metabolic acidosis secondary to renal tubular acidosis. 35 and a low HCO3 level. Conversion of high [AG] metabolic acidosis to hyperchloremic metabolic acidosis: 1. The acidosis caused by these toxins may sometimes present as a normal anion-gap hyperchloraemic Sep 29, 2016 · Hyperchloremic metabolic acidosis was observed in most of cases of toluene intoxication and is indicative of distal tubular acidosis. The severity of clinical presentation and treatment depends on the underlying cause of the metabolic disorder. Liver injury and c. Hypokalemic paralysis and renal failure are life-threatening complications. Toluene sniffing, frequently described under the generic category of ‘‘glue sniffing,’’ is a potential cause of normal anion gap metabolic acidosis due to distal renal tubular acidosis. Although they are often used interchangeably, “acidosis” is separate from “acidemia,” which is a serum pH lower than 7. The three most common ones to consider are methanol , ethylene glycol and salicylates. Nov 1, 2019 · The final diagnosis was toluene intoxication with severe hypokalemia and metabolic acidosis. 3 Among these, 78% were associated with a normal anion gap in the plasma. On the other hand, the final product of toluene metabolism, hippuric acid can accumulate, elevating the anion gap and causing a high anion Jul 1, 2022 · Aspirin itself is a strong acid, and toxic levels do directly contribute to the AGmetabolic acidosis, but a major component of the AG metabolic acidosis that develops with aspirin poisoning is due to the accumulation of multiple endogenous organic acids including lactic acid and ketoacids. Mar 25, 2012 · Toluene, an industrial solvent that can be abused as an inhalant, may cause confusion and disorientation in addition to metabolic acidosis, hypokalemia, hypophosphatemia, rhabdomyolysis, and elevated creatine kinase level. 4°C); therefore, it is a significant fire hazard at room temperature. Awareness and comprehension of those substances associated with metabolic acidosis will facilitate the diagnosis and treatment of poisoned patients. Nov 3, 2022 · In conclusion, this patient’s laboratory abnormalities of profound hypokalemia with severe acidemia, from mixed metabolic acidosis (wide-gap and normal-gap) and respiratory acidosis, were caused by toluene toxicity. Urine anion gap is used to diagnose metabolic acidosis of a normal anion gap variety; however, pitfalls exist when using urine anion gap in the setting of toluene Jul 17, 2023 · Pearls and Other Issues. Therefore, we need not consider the various causes of hypertensive or normotensive renal potassium wasting with metabolic alkalosis. 7 Chronic acetaminophen ingestion, especially by Profound Metabolic Acidosis And Hypokalemia Secondary To Toluene Toxicity Abstract Send to Citation Mgr. Toluene abuse with glue or paint thinner sniffing can cause hippuric metabolic acidosis that presents with a normal plasma anion gap but Profound Metabolic Acidosis And Hypokalemia Secondary To Toluene Toxicity Abstract Send to Citation Mgr. Mar 23, 2010 · Metabolic acidosis is a common acid–base disorder that can occur acutely (lasting minutes to several days) or chronically (lasting weeks to years). 400 (7. 6 Hypokalemia in toluene intoxication is caused primarily by increased renal potassium loss secondary to increased excretion of hippurate, a major metabolite of toluene. Intravenous potassium administration and hydration effectively corrected the electrolyte and acid-base alterations; weakness resolved and the patient was discharged. Liver injury and rhabdomyolysis are common. A metabolic acidosis reduces the plasma bicarbonate and blood pH. Toluene intoxication has long been associated with the development of type 1 (distal) renal tubular acidosis (RTA), which causes a normal anion gap hyperchloremic metabolic acidosis and hypokalemia . The term “toxic alcohols” is a collective term that includes methanol, ethylene glycol, and isopropyl alcohol. 2009 Aug;54 (8):1115-7. Methanol poisoning is most often due to accidental or intentional ingestions, and Apr 11, 2022 · Next: Emergency Department Care. Renal failure. These include metabolic acidosis associated with a normal anion gap Jan 20, 2019 · The hallmark complications of toluene toxicity are renal tubular acidosis and hypokalemic paralysis. The increase in the anion gap is due to the accumulation of unmeasured organic anions, such as lactate or acetoacetate and beta-hydroxybutyrate, as occurs Dec 16, 2015 · Isopropanol alcohol, due to the absence of an alpha-carbon, could only be metabolized to a keto- group and contributes to an osmolar gap but not high anion gap metabolic acidosis in poisoning encounters. May 8, 2023 · Normal physiological pH is 7. Arterial or venous blood gases. Toluene is less dense than water and will float on The causes of potassium depletion include vomiting, diarrhea, renal tubular acidosis (RTA), toluene toxicity, diuretic use, Bartter and Gitelman syndromes, and acquired or hereditary hypertensive renal potassium wasting disorders ( Fig 2 ). 2. Inhalation of toluene (eg by 'glue-sniffing') may cause either a high anion-gap or a normal anion gap acidosis. The approach to a patient with acute weakness can be challenging. The result is non-anion gap metabolic acidosis and K + depletion. Common agents encountered include essential oils like eucalyptus oil in children, kerosene, petroleum, turpentine and toluene. In certaincases,however,thestandardworkupfortheseprob-lems does not reveal an etiology, and other diagnoses must ABSTRACT. Her initial presentation mimicked hypokalaemic periodic paralysis, but toxicology screening of her blood and urine revealed the correct diagnosis of toluene poisoning. The toxicity Aug 13, 2021 · A similar mechanism also explains why patients who inhale toluene (via “glue sniffing” or spray paint inhalation) often present with severe hyperchloremic hypokalemic metabolic acidosis. metabolic acidosis with ethylene glycol poisoning and formic acid is the metabolite responsible for metabolic acidosis with methanol poisoning. (N Engl J Med Toluene is a clear, colorless, volatile liquid with a sweet, pungent, benzene-like odor. In this case, at the emergency department, he was immediately intubated due to acute respiratory failure type 2. 4 Toluene toxicity. overproduction of hippuric acid plays a more important role in the genesis of metabolic acidosis than was previously believed. 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 ass …. oh nb np mt eu re yp yp rn ut 