Renal Tubular Acidosis Associated with Toluene “Sniffing”

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Abstract
"Sniffing" of toluene-containing substances, such as paint, paint thinners and glue, has been thought to be associated primarily with neurologic complications. In our study causality is documented between toluene sniffing and a severe renal tubular acidification defect. Toluene was an ingredient (60.4 per cent) of the paint sniffed by one patient, and pure toluene was sniffed by the other. Both had toluene in the blood. The tubular defect was documented by the presence of metabolic acidosis (pH, 7.2 to 7.3) with a normal "anion gap," hyperchloremia (level of 118 to 120 mEq per liter) and an inappropriately high urinary pH (>6.0). There was no evidence of azotemia, or of excessive excretion of bicarbonate, phosphate, amino acids or glucose in the urine. Complete recovery, followed by recurrence of the tubular defect, was demonstrated on several occasions during avoidance and use of toluene "sniffing." 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. (N Engl J Med 290:765–768, 1974)

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