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Metabolic acidosis in toluene sniffing

Published online by Cambridge University Press:  04 March 2015

Jon Tuchscherer  and
Habib Rehman
Jon Tuchscherer
Affiliation:
Department of Medicine, University of Saskatchewan, Regina, SK
Habib Rehman*
Affiliation:
Department of Medicine, Regina General Hospital, Regina, SK
*
Department of Medicine, Regina Qu'Appelle Health Region, Regina General Hospital, 1440 – 14th Avenue, Regina, SK S4P 0W5; [email protected]

Abstract

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Toluene sniffing, frequently described under the generic category of “glue sniffing,” is a potential cause of normal anion gap metabolic acidosis due to distal renal tubular acidosis. Urine anion gap is used to diagnose metabolic acidosis of a normal anion gap variety; however, pitfalls exist when using urine anion gap in the setting of toluene sniffing. We present the case of a young woman who had a normal anion gap metabolic acidosis due to toluene sniffing and an unexpectedly low urine anion gap. In such a scenario, the urine anion gap will underestimate the rate of ammonia excretion when the conjugate bases of acids other than HCl are excreted in large quantities. Estimation of the urine osmolal gap will provide a more accurate ammonia excretion rate in these circumstances. The challenges in interpretation of the urine anion gap and ammonia excretion in the setting of distal renal tubular acidosis due to toluene toxicity are discussed.

Keywords

anion gapglue sniffingmetabolic acidosisosmolal gaptoluene
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 4 , July 2013 , pp. 249 - 252
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

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