Substance
Toluene
Common name or Trade name
C₆H₅CH₃
C7H8
甲苯:
Route:
inhalation of fumes, ingestion, or transdermal absorption [1, 2]
Exposure:
77% were male and mean age was 23.5 years [3]
Involving system
CNS:
marked atrophy of the lower cervical spinal cord, thoracic spinal cord, and
conus medullaris. [4]
Reversible
symmetrical white matter changes [ 5]
Lung:
aspiration pneumonitis. [2]
CV
system: potential arrhythmogenic effect of endogenous
catecholamines, occasionally resulting in fatality.[6]
Kidney: Renal glomerular injury (proteinuria)戊 renal tubular acidosis[2]
Muscle:
Rhabdomyolysis occurred in 80% of patients, probably due to hypokalemia and
hypophosphatemia [3, 7]
Cardiopulmonary failure [1]
The
cause of death was in all cases due to cardiac rhythm abnormalities. [7]
Presentation
Chronic: mild cognitive
impairment, hearing impairment, dysarthria, marked hyperreflexia of the limbs,
spastic paraplegia, slight impairment of deep sensation, and urinary
disturbance. 4 stimulus-sensitive spinal myoclonus [8]
Acute: Severe hypokalemia and
acidosis.
. Biliary tract injury (alkaline phosphatase
and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular
injury is common.
Altered mental status, severe acidosis, hypokalemia and acute
oliguric renal failure. [3, 7]
Symptomatic hypokalemia [2]
Adrenal insufficiency secondary to bilateral adrenal hemorrhage [9]
Antidote and Treatment
No antidote
Standardly supportive treatment
Disposition
If asymptomatic, observe 6 hours, and
discharge when the CXR is unremarkable.[2]
Poor in patients who have altered mental status, renal failure,
severe acidemia and female gender, and patients with these characteristics
should be considered to be treated in an intensive care unit. [7]
References
[1]https://pubmed.ncbi.nlm.nih.gov/24164003/
[2]. Goldfrank’s toxicologic emergencies. 11th ed. P.
1415~1417
[3].https://pubmed.ncbi.nlm.nih.gov/22642292/
[4]https://pubmed.ncbi.nlm.nih.gov/32238742/
[5].https://pubmed.ncbi.nlm.nih.gov/25117062/
[6]. https://pubmed.ncbi.nlm.nih.gov/9140324/
[7].https://pubmed.ncbi.nlm.nih.gov/26282250/
[8]https://pubmed.ncbi.nlm.nih.gov/10845207/
[9]https://pubmed.ncbi.nlm.nih.gov/9711204/
