Toluene compound is used in many commercial and industrial applications. The most common application of toluene is used as an industrial solvent, which can lead to intentional, accidental, and environmental intoxication. In addition, toluene is a widely used volatile drug for recreational purposes through inhalation, that is, through sniffing or huffing, as it produces acute neurological effects which people enjoy. However, acute toluene toxicity affects all body organs and produces remarkable alterations such as metabolic acidosis, hypokalemic paralysis, rhabdomyolysis, and liver injury. Therefore, toluene toxicity can have fatal consequences if proper preventive measures are not followed, and timely medical assistance is not provided to an exposed person.

What Are the Primary Sources of Toluene Exposure?

Emission from automobiles is the primary source of toluene exposure in the environment.
Indoor toluene exposure occurs through household products such as paints, nail polish, adhesives, and synthetic fragrances.
Industrial use of toluene is also a source of exposure. These include toluene solvent, painting, and printing processes.

What Are the Uses of Toluene?

Toluene is present in many products, such as cigarettes, pharmaceuticals, adhesives, and perfumes. Some common uses of toluene include:

Toluene is mainly used as a polymer in manufacturing plastic soda bottles, nylon, and polyurethanes.
Toluene is used in cosmetic nail polishes to make them look smooth and also can be applied easily. The chemical is also used in nail paint removers in the salon because toluene effectively dissolves other substances.
Toluene is formed from a considerable amount of energy and is a very dense chemical. Because of this property, toluene increases the gasoline octane rating in an external combustion engine.
The compound is widely used as a solvent in many organic laboratories as it can dissolve other chemical substances, mainly organic compounds.
Toluene is used in leather and printing processes and as a solvent in lacquers, paints, thinners, correction fluids, and glues.
Toluene is added to external and internal paint material during construction to apply pain easily and dry paint effectively.
The most surprising use of toluene is that it helps to extract cocaine from coca leaves while manufacturing Coca-Cola.

What Are the Symptoms of Toluene Toxicity?

The symptoms of toluene toxicity are:

Headaches.
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Drowsiness.
Euphoria.
Dizziness.
Seizures.
Hallucinations.
Tremors.
Coma.
Nausea and vomiting.
Respiratory depression.
Ventricular arrhythmia.
Electrolyte imbalance.
Dilated pupils.
Tingling or numbness of the skin.

What Are the Adverse Effects of Toluene Toxicity?

The adverse effects of toluene toxicity include:

Central nervous system depression.
Cerebral atrophy.
Swollen liver.
Muscle weakness.
Kidney necrosis.
Impaired speech.
Brain damage.
Loss of muscle control.
Fatigue.
Memory loss.
Breathing difficulty.
Impaired hearing, vision, and speech.
Irritation in eyes and upper respiratory tract.

How Is Toluene Toxicity Managed?

Toluene toxicity is treated in the following ways:

Toluene exposure mainly occurs through vapor inhalation. Therefore, the rescuer should safely decontaminate the person exposed by wearing protective gear. Since there is no antidote therapy for toluene toxicity. The rescue should ensure that initial treatment focuses on securing respiratory and cardiac functions.
Supportive treatment includes the removal of airway obstruction and ensuring pulse and respiration. The treatment is done with proper monitoring of the vitals, oxygen therapy, and mechanical ventilation support in case of emergency.
If the exposure is through inhalation, inducing emesis is not recommended, and activated charcoal therapy is also limited in case of toluene toxicity. However, activated charcoal can also be effective if the poisoning is through a mixed overdose.
The activated charcoal slurry can be administered in alert and asymptomatic patients with gag reflexes.
In severe cases of toluene toxicity, endotracheal intubation is also done to secure the airway. In addition, aerosolized bronchodilators are used to treat bronchospasm in a person. But the healthcare provider should avoid drugs like catecholamines, isoproterenol, and epinephrine in toluene toxicity as they can cause cardiac arrhythmias.
An exposed person with a medical history of hypotension, cardiac arrhythmias, seizures, and coma should be treated with conventional methods and according to advanced life support protocols and guidelines.
Toluene toxicity is mainly based on acid-base and electrolyte alterations. Therefore, monitoring the case carefully, potassium replacement, and a person's hydration are critical parts of the treatment plan.

How Can We Prevent Toluene Exposure?

People can prevent toluene exposure in the following ways:

First, proper ventilation is vital to avoid toluene exposure, especially in high-risk areas where toluene is used extensively in evaporating, such as exhaust processes and spray booths.
Occupational exposure to toluene can also be minimized by proper ventilation to protect workers from unnecessary exposure.
Water-based materials should be used as a substitute for toluene in degreasing and cleaning applications, water-based adhesives or paints, and rollers or brushes for spray applications.
People handling or working with toluene in any way should wear proper protective equipment to avoid direct skin contact. Nitrile or neoprene gloves are mainly recommended for handling toluene compounds or chemicals.
Toluene spray application should be made away from the ignition source and in a closed spray to restrict exposure.
Proper training on emergency procedures, appropriate work practice, and personal protective equipment is essential for people working with toluene.

What Is the Differential Diagnosis for Toluene Toxicity?

Chemical burns.
Acute kidney injury.
Acute contact dermatitis.
Hypocalcemia.
Diabetic ketoacidosis.
Schizophrenia (emergent treatment).
Peptic ulcer disease.
Viral hepatitis.
Smoke inhalation injury.
Pediatric reactive airway disease.
Aspiration pneumonitis.
Rhabdomyolysis.

Conclusion

Exposure to toluene due to intentional intoxication or inhalation can cause the death of a person. In addition, the toxicity can cause various neurological symptoms, organ dysfunction or injury, and severe metabolic alterations. Therefore, it is crucial for a person working with toluene exposure to get regular checkups and follow preventive measures to minimize the associated risk. Furthermore, since no antidote treatment for toluene intoxication and treatment is mainly supportive, it can lead to severe complications and health hazards if timely medical help is unavailable. Therefore, toluene should be handled carefully, and people should avoid its recreational use.