Automobile Paint Reducer Induced Acute Kidney Injury: A Case Series
Abstract
The various aspects of the automobile industry also carry with it the risk for occupational health hazards with it. Toluene has also evolved as a commonly used drug by substance abusers. Accidental exposure or self-poisoning with these substances has been reported in literature. These substances can also cause distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis and interstitial nephritis, rhabdomyolysis and myoglobinemia.
In this series, we report about three patients who developed renal manifestations because of organic solvents. Two of the three patients had ingested the paint reducer substance and the third one was addicted to sniffing the toluene based paint reducer. All the patients had in taken these substances s with suicidal intent and developed acute kidney injury (AKI) and severe metabolic acidosis. One of the patients had features of rhabdomyolysis as well. The third patient was a substance abuser and had inhaled higher than usual dose and developed severe and refractory acidosis and mild kidney injury and required Renal Replacement Therapy (RRT) for acidosis. All the patients eventually recovered their kidney functions and were doing well during their follow-up.
Toluene based organic solvents lead to acute neurological symptoms, accompanied by severe metabolic alterations, organ injury and dysfunction. An association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication has been observed. The management of acute toluene toxicity is mainly conservative, consisting of electrolytes correction, acid-base and fluid abnormalities and renal replacement therapy in severe AKI.
Organic solvent exposure may result in acute tubular necrosis, rhabdomyolysis, RTA and AKI irrespective of the intake route. Clinical suspicion of organ dysfunction and failure and timely induction of supportive care leads to a good outcome.
Keywords
How to Cite
References
Sato A, Yonekura I, Kaneko T, Koizumi T. Renal disorders induced by organic solvents. Sangyo Igaku. 1988;30:85–96. https://doi.org/10.1539/joh1959.30.85
Daniell WE, Couser WG, Rosenstock L. Occupational solvent exposure and glomerulonephritis. A case report and review of the literature. JAMA. 1988;259:2280–83. https://doi.org/10.1001/jama.259.15.2280
Hotz P. Occupational hydrocarbon exposure and chronic nephrop-athy. Toxicology. 1994;90:163–283. https://doi.org/10.1016/0300-483X(94)90091-4
Jacob S, Hery M, Protois JC, et al. Effect of organic solvent exposure on chronic kidney disease progression: The GN-Progress cohort study. J Am Soc Nephrol. 2007;18:274–81. https://doi.org/10.1681/ASN.2006060652
Jacob S, Hery M, Protois JC, et al. New insight into solvent-related End Stage Renal Disease: Occupations, products and types of solvents at risk. Occup Environ Med. 2007;64(12):843–8. https://doi.org/10.1136/oem.2007.032482
Martínez-Alfaro M, Alcaraz-Contreras Y, Cárabez-Trejo A, Leo-Amador GE. Oxidative stress effects of thinner inhalation. Indian J Occup Environ Med. 2011;15:87–92. https://doi.org/10.4103/0019-5278.93195
Rahimi HR, Agin K, Shadnia S, et al. Clinical and biochemical analysis of acute paint thinner intoxication in adults: A retro-spective descriptive study. Toxicol Mech Methods. 2015;25:42–7. https://doi.org/10.1016/j.etap.2016.05.001
Singh R, Vinayagam S, Vajifdar H. Methemoglobinemia as a result of accidental lacquer thinner poisoning. Indian J Crit Care Med. 2012;16:44–7. https://doi.org/10.4103/0972-5229.94435
Rosenberg NL, Kleinschmidt-DeMasters BK, Davis KA, et al. Toluene abuse causes diffuse central nervous system white matter changes. Ann Neurol. 1988;23(6):611–4. https://doi.org/10.1002/ana.410230614
Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological profile for toluene. Atlanta, GA: ATSDR; 2011. Available from: https://www.atsdr.cdc.gov/substances/toxsub-stance.asp?toxid=29
Camara-Lemarroy CR, Rodríguez-Gutiérrez R, Monreal-Robles R, et al. Acute toluene intoxication–clinical presenta-tion, management and prognosis: A prospective observational study. BMC Emerg Med.2015;15:19. https://doi.org/10.1186/ s12873-015-0039-0
Benignus V. Health effects of toluene: A review. Neurotoxicology. 1981;2(3):567–88. Available from: https://pubmed.ncbi.nlm.nih.gov/7038560/
Blake RI, Coon M. On the mechanism of action of cytochnome P-450. Evaluation of homolytic and heterolytic mechanisms of oxygen-oxygen bond cleavage during substrate hydroxylation by peroxides. J Biol Chem. 1981;256(23):12127–33. https://doi.org/10.1016/S0021-9258(18)43242-5
Mizutani T, Oohashi N, Naito H. Myoglobinemia and renal failure in toluene poisoning: A case report. Vet Hum Toxicol. 1989;31(5):448–50. Available from: https://pubmed.ncbi.nlm. nih.gov/2603363/
Gupta RK, Van der Meulen J, Jonhny KV. Oliguric acute renal failure due to glue sniffing. Case report. Scand J Urol Nephrol. 1991;25(3):247–50. https://doi.org/10.3109/00365599109107958
Carlisle EJ, Donnelly SM, Vasuvattakul S, et al. Glue-sniffing and distal renal tubular acidosis: Sticking to the facts. J Am Soc Nephrol. 1991;1(8):1019–27. https://doi.org/10.1681/ASN. V181019
Bonzel KE, Muller-Wiefel DE, Ruder H, et al. Anti glomerular basement membrane antibody mediated glomerulonephritis due to glue sniffing. Eur J Pediatr. 1987;146(3):296–300. https://doi.org/10.1007/BF00716479
Taverner D, Harrison DJ, Bell GM. Acute renal failure due to interstitial nephritis induced by ‘glue sniffing’ with subse-quent recovery. Scott Med J. 1988;33(2):246–7. https://doi.org/10.1177/003693308803300208
King MD, Day RE, Oliver JS, et al. Solvent encephalopathy. Br Med J (Clin Res Ed). 1981;283(6292):663–5. https://doi. org/10.1136/bmj.283.6292.663
Wada K, Nakayama K, Koishikawa H, et al. Symptomatological structure of volatile solvent-induced psychosis: is “solvent psychosis” a discernible syndrome? Nihon Arukoru Yakubutsu Igakkai Zasshi = Japanese Journal of Alcohol Studies & Drug Dependence. 2005;40(5):471–4. PMID: 16316074.
Parker MJ, Tarlow MJ, Milne Anderson J. Glue sniffing and cerebral infarction. Arch Dis Child. 1984;59(7):675–7. https://doi.org/10.1136/adc.59.7.675
Malm G, Lying-Tunell U. Cerebellar dysfunction related to tol-uene sniffing. Acta Neurol Scand. 1980;62(3):188–90. https://doi.org/10.1111/j.1600-0404.1980.tb03021.x
Chou PT, Lee WC, Ho YS. [Aplastic anemia secondary to glue sniffing—report of 2 cases]. Taiwan Yi Xue Hui Za Zhi. 1985;84(5):625–9. Chinese. PMID: 3862759.
McIntyre AS, Long RG. Fatal fulminant hepatic failure in a ‘solvent abuser’. Postgrad Med J. 1992;68(795):29–30. https://doi.org/10.1136/pgmj.68.795.29
Kenyeres I, Baloch I, Somogyi E. Pathogenesis of lung changes caused by inhalation of organic solvents. Morphol Igazsagugyi Orv Sz. 1978;18(1):23–7. Available from: https://pubmed.ncbi. nlm.nih.gov/634296/
Shepherd RT. Mechanism of sudden death associated with vola-tile substance abuse. Hum Toxicol. 1989;8(4):287–91. https://doi.org/10.1177/096032718900800406
Moss AH, Gabow PA, Kaehny WD, et al. Fanconi’s syndrome and distal renal tubular acidosis after glue sniffing. Ann Intern Med. 1980;92(1):69–70. https://doi.org/10.7326/0003-4819-92-1-69
Patel R, Benjamin Jr. J. Renal disease associated with toluene inhalation. J Toxicol Clin Toxicol. 1986;24(3):213–23. https://doi.org/10.3109/15563658608990459
Streicher HZ, Gabow PA, Moss AH, et al. Syndromes of tol-uene sniffing in adults. Ann Intern Med. 1981;94(6):758–62. https://doi.org/10.7326/0003-4819-94-6-758
Holtz J. Acute poisoning due to oral intake of an organic solvent. Schweiz Med Wochensohr. 1992;122(47):1810–3. Available from: https://pubmed.ncbi.nlm.nih.gov/1448688/
Ghanei E, Homayooni M, Nasrollahi A. Rhabdomyolysis and thinner intoxication. Med J Islam Repub Iran . 2007;21:162–6, Available from: http://mjiri.iums.ac.ir/article-1-331-en.html
Ngajilo D, Ehrlich D. Rhabdomyolysis with acute tubular necrosis following occupational inhalation of thinners. Occup Med. 2017;67(5):401–3. https://doi.org/10.1093/occmed/kqx048
Efstratiadis G, Voulgaridou A, Nikiforou D, et al. Rhabdomyolysis updated. 2007;11(3):129–37. Available from: https://pubmed.ncbi.nlm.nih.gov/19582207/
Knochel JP, Barcenas C, Cotton JR, et al. Hypophosphatemia and rhabdomyolysis. J Clin Invest. 1978;62(6):1240–6. https://doi.org/10.1172/JCI109244
Taher SM, Anderson RJ, Mcartney R, et al. Renal tubular acidosis associated with toluene “sniffing.” N Engl J Med. 1974;290:765–8. https://doi.org/10.1056/NEJM197404042901403
Copyright and licence
Copyright (c) 2021 Muzamil Latief, Zhahid Hassan, Mohd Latief Wani, Farhat Abbas, Summyia Farooq
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
