Physical Assessment

Manifestations vary, depending on the types of inhalants, amount of substances used and the duration of the use. The physical assessment should include objective and subjective data. The following systems should be assessed. Objective data should be collected with consideration for the possibility of the following disorders.

• Cardiovascular - Anderson & Loomis (2003) cite inhalant induced Cardiac toxicity which encompasses myocardial edema, irreversible myocarditis, fibrosis, and congestive heart failure as resulting from Inhalant abuse. According to Johnston and Adgey (1997) chronic exposure to volatile substances may cause dilated cardiomyopathy or myocarditis. They describe a case in which a 15-year-old boy needed a cardiac transplantation from a two-year history of intermittent glue sniffing. Johnston and Adgey (1997) additionally describe cases of cardiac arrhythmias and myocardial infarction
• Neurologic - According to a University of Washington Web site. Cerebral cortex: damage can cause changes in personality, memory loss, hallucinations and learning problems. Cerebellum: damage can cause problems in balance and movement. Hippocampus: damage may result in the memory problems. Additional information can be obtained from http://faculty.washington.edu/chudler/inhale.html
  Anderson & Loomis (2003) reported Neurologic toxicity is the most recognized and reported chronic side effect of inhaled solvent abuse. Common findings on brain imaging include enlarged ventricles, widened cortical sulci, and cerebral, cerebellar, or brain stem atrophy.
• Respiratory - Cook (1999) reports Coryza, pharyngitis, and pulmonary failure from aspiration consequences of inhaling. According to Palmer (1997) rales, rhonchi bronchitis and pneumonia may be noted. The respiratory condition may be treated without an evaluation of the cause. The diagnosis of Inhalant abuse is often missed. Bykowski, (1999) quotes Dr. Jacobs, chair of the American Academy of Pediatrics' Committee on Substance Abuse “Be sure to consider the possibility of inhalant abuse in a child who has symptoms of asthma, allergies, or hay fever that don't improve despite compliance with varying doses and types of medication.”
• Gastrointestinal - Nausea, vomiting, and abdominal pain may be noted during intoxication and withdrawal. Manifestation of chronic abuse includes anorexia and weight loss. Anderson & Loomis (2003) reported the occurrence of hepatic toxicity.
• Musculoskeletal - Peripheral neuropathy may present as proximal or distal muscle weakness, muscle wasting, absent or decreased tendon reflexes, or paresthesias.
• Urological - The renal tubules may suffer damage from inhalants. Renal toxicity occurs which entails distal renal tubular acidosis, anion-gap acidosis, Fanconi's syndrome, renal calculi, hematuria, proteinuria, and renal failure.
• Hematology - Bone marrow depression is a complication of inhalant abuse. According to Broussard, L. (2000) Long-term inhalant use can result in bone marrow suppression, leading to leukopenia, anemia, thrombocytopenia, and hemolysis.
• HEENT - Often the inhalant is placed in a plastic bag and the fumes are inhaled by mouth (huffing). This causes sores in the mouth or a rash around the mouth. Sniffing causes chronic nosebleeds and sores in the nose. Freezing of the lips and mouth can occur when the substance is inhaled directly from a cylinder. Other manifestations include tinnitus, sneezing, hypersalivation and conjunctival irritation.

Symptoms of asthma, allergies or hay fever that do not improve with medication may be signs of inhalant abuse.