Acidosis and other metabolic abnormalities associated with paint sniffing

Acidosis (arterial pH 6.88 to 7.38) and many other metabolic abnormalities were found in eight patients observed during 16 hospitalizations for paint sniffing. In four episodes, a high anion gap was found, perhaps secondary to an accumulation of metabolites of toluene. The anion gap was normal during 12 episodes, of which seven were associated with a urine pH greater than 5.5 indicating renal tubular acidosis (RTA). Pyuria, hematuria, and proteinuria were frequently observed. There were six episodes of rapidly reversible renal insufficiency (peak serum creatinine values 1.7 mg/dl to 5.4 mg/dl). Hypokalemia (eight episodes) and hypophosphatemia (seven episodes) were also observed. In two patients the urine pH, titratable acid, and ammonium excretion were determined before and after bicarbonate therapy. These results suggested distal but not proximal RTA. Our observations indicate that multiple metabolic abnormalities may result from solvent abuse and suggest guidelines for therapy.