A 38-year-old man is brought to the emergency department confused and agitated. He works at a chemical plant and accidentally inhaled a large amount of industrial solvent. Examination reveals slurred speech, ataxia, nystagmus, and perioral rash. He is tachycardic and his ECG shows a prolonged QTc. His blood alcohol level is undetectable. Which substance class is most likely responsible?
- A Opioid
- B Benzodiazepine
- C Inhalant (volatile solvent) ✓
- D Cocaine
Explanation
Inhalant intoxication from volatile solvents (toluene, benzene, hydrocarbons) produces a rapid alcohol-like CNS depression with slurred speech, ataxia, nystagmus, and euphoria. The perioral rash ('huffer's rash') from contact with solvents and the absence of alcohol on blood testing are characteristic. A critical danger is sensitization of the myocardium to catecholamines, causing fatal ventricular arrhythmias ('sudden sniffing death') — reflected by QTc prolongation here. Inhalants are unique in their cardiac sensitization risk, setting them apart from other CNS depressants.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.