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
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