Cases That Test Your Skills

Serious complications due to ‘huffing’

Current Psychiatry. 2023 June;22(6):41-45 | doi: 10.12788/cp.0368

References

1. Ahern NR, Falsafi N. Inhalant abuse: youth at risk. J Psychosoc Nurs Ment Health Serv. 2013;51(8):19-24. doi:10.3928/02793695-20130612-02

2. Howard MO, Bowen SE, Garland EL, et al. Inhalant use and inhalant use disorders in the United States. Addict Sci Clin Prac. 2011;6(1):18-31.

3. Farkas J. Rhabdomyolysis. Internet Book of Critical Care. June 25, 2021. Accessed February 24, 2023. https://emcrit.org/ibcc/rhabdo/

4. Torres PA, Helmstetter JA, Kaye AM, et al. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J. 2015;15(1):58-69.

5. Muller AA, Muller GF. Inhalant abuse. J Emerg Nurs. 2006;32(5):447-448. doi:10.1016/j.jen.2006.05.018

6. Kozel N, Sloboda Z, De La Rosa M, eds. Epidemiology of Inhalant Abuse: An International Perspective; Nida Research Monograph 148. National Institute on Drug Abuse Research, US Dept of Health and Human Services; 1995. Accessed April 20, 2023. https://archives.nida.nih.gov/sites/default/files/monograph148.pdf

After extensive discussion on the long-term complications of inhalant abuse, Ms. G was motivated, cooperative, and sought care to return to rehabilitation services. The CL psychiatry team collaborated with the social work team to address the psychosocial components of Ms. G’s homelessness and facilitated an application for a local resource to obtain rehabilitation placement and living assistance. Her years of abstinence from inhalant use and success with rehabilitation demonstrate the need for a multimodal approach to manage and treat inhalant use disorder. Outpatient follow-up arrangements were made with local mental health resources.

OUTCOME Improved outlook and discharge

Ms. G reports improved mood and willingness to change her substance use habits. The treatment team counsels her on the acute risk of fatal arrhythmias and end-organ complications of inhalant abuse. They warn her about the potential long-term effects of mood alterations, neurological lesions, and polyneuropathy that could possibly worsen with substance abuse. Ms. G expresses appreciation for this counseling, the help associated with her aftercare, and the referral to restart the 30-day inpatient rehabilitation services. The team arranges follow-up with outpatient psychiatry and outpatient therapy services to enhance Ms. G’s coping skills and mitigate her reliance on inhalants to regulate her mood.

Bottom Line

Inhalant use is a poorly understood form of substance abuse that disproportionately affects vulnerable populations. It can lead to life-threatening medical emergencies such as rhabdomyolysis. Clinicians need to be able to identify and manage inhalant abuse and associated complications, as well as provide appropriate education and counseling to prevent further misuse.

Related Resources

Gude J, Bisen V, Fujii K. Medication-induced rhabdomyolysis. Current Psychiatry. 2023;22(2):39-40. doi:10.12788/cp.0332
Waldman W, Kabata PM, Dines AM, et al. Rhabdomyolysis related to acute recreational drug toxicity--a Euro-DEN study. PLoS One. 2021;16(3):e0246297. doi:10.1371/journal. pone.0246297

Drug Brand Names

Carbamazepine • Tegretol
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Propranolol • Inderal
Quetiapine • Seroquel
Trazodone • Oleptro
Ziprasidone • Geodon