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A New Cause of High Anion Gap Metabolic Acidosis

Charles M. Fischman, MD; James R. Oster, MD

JAMA. 1979;241(16):1713-1715.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

THE INHALATION or sniffing of toluene-containing substances such as transmission fluid and paint thinners appears to have gained recent widespread popularity. The immediate effects reported by many sniffers are a transient state of euphoria, followed by a brief period of light-headedness. Some abusers claim to have lost consciousness.

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).¹ Between 1975 and 1977, three toluene sniffers were admitted to Jackson Memorial Hospital, Miami, with severe acidemia. One patient required several readmissions when the acidosis recurred after repeated inhalation of toluene. We report the changes in acid-base equilibrium that occurred in these patients, including the finding on several occasions of high anion gap metabolic acidosis.

Methods

Venous blood samples were used to measure ketone bodies and the concentrations of lactate, sodium, potassium, chloride, bicarbonate, . . . [Full Text PDF of this Article]

Author Affiliations
From the Department of Medicine Pulmonary Division (Dr Fischman), University of Miami School of Medicine; and the Renal Section (Dr Oster), Medical and Research Services, Veterans Admin-; istration Medical Center, Miami.

Footnotes
Reprint requests to Nephrology Section, Veterans Administration Hospital, 1201 NW 16th St, Miami, FL 33125 (Dr Oster).

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