Clinical presentations

• Acute intoxication: transient euphoria, dizziness, disorientation, slurred speech and ataxia.
• Severe acute complications: loss of consciousness, aspiration, sudden sniffing death from arrhythmia, methemoglobinemia (nitrites) and seizures.
• Subacute and chronic presentations: cognitive impairment, neuropathy, mood disturbance and functional decline attributable to repeated exposure.

Diagnosis & differential

1. Establish temporal association between symptom onset and inhalant exposure or withdrawal.
2. Differentiate from other causes: hypoglycaemia, intoxication with alcohol or sedatives, head injury, stroke, infection, or primary psychiatric illness.
3. Use focused investigations: ECG, pulse oximetry/ABG, methemoglobin level if nitrites suspected, basic labs and imaging when indicated.

Immediate management priorities

• Stabilise airway, breathing and circulation; give high‑flow oxygen to all suspected inhalant intoxication cases.
• Continuous cardiac monitoring for arrhythmia risk and obtain a 12‑lead ECG promptly.
• Treat complications: methylene blue for symptomatic methemoglobinemia, benzodiazepines for seizures and agitation, manage aspiration and respiratory compromise per protocol.

Risk assessment & disposition

• Admit for observation if there is any loss of consciousness, arrhythmia, hypoxia, seizure, or significant comorbidity.
• Consider ICU monitoring for unstable cardiac or respiratory parameters or persistent altered consciousness.
• Outpatient follow‑up appropriate for mild, resolved intoxication — arrange addiction services referral if ongoing use.

Long‑term management

• Address inhalant use disorder with psychosocial interventions: brief motivational interviewing, CBT, family therapy and linkage to community resources.
• Assess and manage neurocognitive and neurological sequelae — cognitive rehabilitation, neurology referral and supportive therapies as needed.
• Coordinate social care: housing, education or employment support, and safeguarding for adolescents.

Prevention & harm reduction

• Community education about risks, early signs and available support services.
• Restrict access to commonly misused household products where feasible, and promote alternatives for at‑risk youth.
• Advise harm reduction measures: avoid enclosed spaces, do not mix with other depressants, seek immediate help for collapse or collapse.

Key takeaways

• Unspecified inhalant‑related disorders require rapid triage for medical complications and longer‑term addiction and neurorehabilitation care where indicated.
• Stabilise ABCs, monitor cardiac rhythm and treat specific toxicities like methemoglobinemia.
• Engage psychosocial supports and community resources to reduce harm and support recovery.