Hi Dr Bernard here.
Recreational inhalants are all unsafe.
Any psychoactive effect they might have, cannot be uncoupled with permanent damage to the
user’s body, as I will tell you about in this video.
Don’t do it.
A Man Inhaled Paint Thinner Fumes For 7 Hours Nonstop.
This Is What Happened To His Kidneys.
CJ is an 18 year old man presenting to the emergency room with an erratic heart rhythm.
Paramedics tell the admitting nurse that they found him slouched over on the ground, with
a distinct lack of muscle tone.
Someone described him as “floppy, and sloppy.”
As he tries to correct the record, CJ speaks incoherent words in an unusually high pitched
voice.
Earlier that day, CJ was in his regular routine.
Every morning before class, he would find a way to make it so that the only thing that
was put into his lungs for an appreciable amount of time, was the fumes of paint thinner.
Sometimes he wouldn’t even make it to class because he’d spend so much time doing his
thing.
Earlier in his life, CJ had some family issues.
When he was in his early teens, one of his friends had an older brother who worked in
a rough environment, and picked up some techniques to have quick pick me ups during the short
breaks they’d get.
These “techniques” sometimes involved industrial grade chemicals.
The first time CJ tried putting these into his lungs, he felt something tense up just
under his neck, like it was a blood vessel squeezing itself hard.
He thought he could hear a kettle pot whistle in his ears.
When he exhaled, he tried talking and he could hear his voice echo, each repeat being higher
pitched than the last.
And it was a short lived effect.
As the time passed, CJ started doing this more and more often, each session being longer
than before.
I can stop anytime, he thought.
At first, he kept doing it because he thought he felt bored.
He believed it took his mind off all the other problems happening in his life.
But one day, before school, CJ just started doing it, and he wouldn’t stop doing it.
He hadn’t realized he had walked outside and brought his materials with him.
And as he was found sprawled out by the train tracks, someone walking by found him slumped
over and out of his mind.
911 was called and CJ is brought to the emergency room where we are now.
At examination, the medical team finds that CJ is confused and disoriented.
One of the words used to describe CJ’s appearance was floppy.
And when the medical team did an exam, they found profound muscle weakness in CJ’s arms
and legs.
Clearly, the inhalants did something to his brain because he doesnt know where he is.
Maybe it did something to his muscles because he’s much weaker than normal.
But, the muscles are controlled by the brain through the nerves, so something could be
wrong there too.
Are these problems happening because the inhalant did something to just his brain?
Or did it do something to just his nerves?
Or just his muscles?
Or is it a combination of these?
And how would the medical team figure this out?
When you breathe, the gas from that air is put into your blood, and exchanged for carbon
dioxide exhaled.
In the setting of inhalant misuse, the inhalant-soaked blood is then pumped to the heart so it can
circulate all throughout the body.
This can start to explain the effects from the chemicals.
But if you look at paint thinner physically, it gives us some clues as to what’s happening.
In this container is water, and when paint thinner is added, you’ll see that the two
don’t mix.
And that’s because paint thinners are made of oils which don’t mix with water.
One of these paint thinner oils is a chemical named Toluene, which is lipophilic.
-Philic meaning affinity for and lipo- meaning fat.
This means that it preferentially mixes with fat tissue in the body, meaning that when
it’s inhaled and in the bloodstream, it doesn’t want to stay in.
It wants to get into body tissue and organs that have more fat.
And if the brain is made of at least 60% fat, then, CJ experiencing psychoactive effects
from inhaling the paint thinner should make sense.
As the toluene floods in, it immediately starts to make neurochemical changes.
The combination of all these happening at once is what we think causes the effect, and
the brain scrambles to try to readapt itself, to return to normal, explaining why the effect
is so short lived.
But as time and repeated misuse continue, the brain and the nerves keep experiencing
this change as parts of the nervous system start to degrade, ending in permanent damage.
The confusion.
The disorientation.
The incoherent words in an unusually high pitched voice when trying to correct the record.
All of this explaining how CJ’s brain is being impacted, and maybe suggesting that
permanent damage has already happened, but this wasn’t his only problem.
When he presented to the emergency room, the medical team noted that CJ’s heart was beating
erratically.
The heart is connected to the brain by the nerves, but, the heart has its own pacemaker.
It’s supposed to keep its own rhythm.
The heart is a cardiac muscle.
The arms and legs are moved by skeletal muscle.
These two tissues are very similar, but they’re not directly connected.
And they’re not connected to the brain by the same nerves.
CJ having an erratic heart rhythm, and skeletal muscle weakness, suggests that the paint thinner
somehow impacted all different kinds of muscles in his body, but how is it doing that?
A blood test finds that CJ is not only dehydrated, but he has hypokalemia.
Hypo meaning low.
Kal- referring to potassium, an element that carries a single, positive charge in ionic
form in the body that’s formally known as Kalium as shown by its symbol on the periodic
table of elements, and emia meaning presence in blood.
Low potassium presence in blood.
This was found with acidemia.
Acid, formally defined as the concentration of hydrogen ions in solution, but in this
case suggesting a metabolic dysfunction in his body.
Both of these give the medical team some more clues as to what’s happening.
Potassium has important functions in the body, one of them being to provide a signal for
cells to do things.
In muscles, potassium signals for relaxation.
If there’s low potassium presence in blood, then it means that possibly his heart can’t
relax properly.
This could explain why his heart rhythm was so erratic.
Blood vessels are a muscle too, and if CJ has hypokalemia, then it’s possible that
his blood vessels can’t relax, so they stay constricted.
This means that blood has a hard time flowing through to his muscles to supply oxygen.
CJ becomes profoundly weak to the point where he’s floppy in tone.
And as the medical team look further at the blood test, they find that parts of his muscles
have started to die, because they’re now floating around in his blood.
This is called rhabdomyolysis.
Rhabdo meaning striated or in this case skeletal.
Myo meaning muscle.
Lysis meaning a breaking down of.
Skeletal muscle breakdown.
This is life threatening, it’s a medical emergency, and it looks like it is happening
independent of the permanent brain damage done by his paint thinner misuse.
But how did toluene do this?
This brings us back to lipophilicity.
Some inhaled toluene vapors go right to the brain, but some will also flow to other parts
of the body.
One of which is the liver, known as the detox center in humans that breaks chemicals down.
Lipophilic compounds tend to stay absorbed in the body, so one goal of liver metabolism
is to make chemicals more hydrophilic, so that the compound can then dissolve in water,
be filtered out by the kidneys and concentrate in the urine.
In the liver, toluene is “broken down” to hippuric ACID, and that might explain why
he has ACIDemia, but something’s wrong.
This brings us to an idea called equilibrium.
Hippuric acid is a combination of hippurate and Acid.
Both existing in balance, because acid is the concentration of hydrogen ion.
Hippurate meets the goals of liver metabolism, because the kidneys eagerly filter it out
of the blood and concentrate it into the urine.
But, hippurate isnt supposed to be there.
And there’s a lot of it, because CJ had been inhaling the solvent for so many hours
before.
And because of equilibrium, hippurate has a negative charge.
Urine is electrically neutral.
It’s not going to have a charge.
Meaning that for every hippurate molecule filtered, a positively charged chemical must
follow.
And if potassium has a plus one charge, then this explains his hypokalemia, because potassium
is getting sucked out of his blood to match hippurate excretion in the urine.
Hippurate gets filtered quicker than acid, leaving the hydrogen behind, which is why
the medical team found CJ had acidemia.
The kidneys are doing their job of filtering the blood correctly here.
But the result of this hypokalemia, is going to shut the kidneys down, bringing us back
to rhabdomyolysis.
The muscle remnants floating around CJ’s blood, circulate his body, and make their
way to the kidneys.
It’s here where they get filtered out too, when, they’re not supposed to be there.
They contain iron pigments and proteins that collect in, blocking flow to the kidneys.
They damage the inner lining of the tubules that do the filtering.
And then blood flow to the kidneys gets restricted.
The unstable iron reacts with and destroys the kidneys causing permanent damage.
But this still isn’t the end of CJ’s problems.
When he presented to the emergency room, his heart rhythm was erratic.
As his condition continued to get worse as he was waiting for care, CJ’s heart started
shaking in place, not actually beating and pumping blood because of his hypokalemia.
The toluene misuse targeted his brain, his nerves, and his muscles, and his kidneys independently,
and destroyed his body, permanently.
As CJ was quickly resuscitated, he was transferred into the intensive care unit.
But as the days pass, the medical team notes that his kidneys no longer function in the
way they should in a normal 18 year old man.
They find that he has cognitive deficits, and motor coordination issues indicating neuronal
damage.
Because he was only 18 years old at the time, his brain was supposed to be still in development.
It may still be able to develop in spite of his paint thinner misuse, but there was evidence
of permanent damage all across his body.
And he’s going to have dysfunctions in many more parts of his life going forward because
of this misuse.
In English, they’re called “Inhalants,” but the toxicology of different chemicals
can vary.
Toluene is an aromatic hydrocarbon.
Aromatic refers to this benzene ring, not necessarily meaning aromatic as in smell,
although it does smell in this case, and toluene happens to be a relatively “simple” molecule
compared to other inhalants.
Some chemicals are halogenated, meaning they have chlorine, or fluorine, and those are
known to cause sudden cardiac death when misused.
Sometimes what gets inhaled are refrigerants, like what you find in certain spray bottles
and those can cause toxic leukoencephalopathy, where there’s a loss of brain mass, degeneration
of white matter, all of which is permanent.
If you’re exposed to some permanent or white board markers a few seconds every few days,
incidentally, you’re not likely to get permanent brain damage from that.
Of course you want to do your best to not inhale those fumes from those for prolonged
times.
But if you deliberately misuse it like how CJ was, by making it the only thing that inhaled
for an appreciable amount of time, that’s going to cause problems.
Similarly, industrial workers can be exposed to these chemicals for hours, and negative
impacts can happen if their workplace doesnt have the right safety measures in place, or
if they don’t take the precautions, either by accident or incidentally.
For CJ, the parts of his brain and his kidneys, and his muscles aren’t coming back.
When he was no longer critically ill, he was discharged from the hospital having made a
recovery.
Thanks so much for watching.
Take care of yourself.
And be well.