Research needs to be carried out in Sri Lanka to further explore the extent of

the important yet unspoken social problem of inhalant abuse, an unspoken

social problem in Sri Lanka that is not given the same attention as smoking

and alcohol abuse.

This recommendation was made in a case report on “The first reported case

of thinner (a solvent used to thin oil-based paints) sniffing in a Sri Lankan

adolescent” which was authored by Y. de Silva and K. Wickramasinghe (both

attached to the Colombo South Teaching Hospital, Kalubowila), and D.S.

Wijesekara (attached to the Sri Jayewardenepura University Medical

Sciences Faculty Paediatrics Department as a Senior Lecturer Grade I), and

published in the Sri Lanka Journal of Child Health (51)4 in December 2022. De Silva et al. report a case of thinner sniffing in an adolescent which caused

the loss of consciousness and subsequent drowsiness.

Case report

A 13-year-old boy was admitted to the Paediatric Casualty Ward at the

Colombo South Teaching Hospital in Kalubowila with the complaint of the

loss of consciousness with an opened thinner bottle nearby. He was a child

with a history of petrol sniffing, who had undergone treatment, and was

now off the habit for three years. He was found in his grandmother’s garden,

unconscious with frothing; however, the exact duration of unconsciousness

was not known, but would have been about roughly 20 minutes. He was

initially brought to a General Practitioner within 15 minutes of him being

found. Although he had regained consciousness, he remained persistently

drowsy. He was subsequently transferred to the hospital by ambulance. The

drowsiness persisted for about two hours, and then gradually subsided.

He was hemodynamically (how the blood flows through one's arteries and

veins, and the forces that affect one's blood flow) stable and no focal

neurological signs (impairments of the nerves, spinal cord, or brain function

that affect a specific region of the body) were found. He admitted that he

had been attracted to the smell of thinner, and that he had spent about 30

minutes sniffing it continuously. He had then felt lightheaded and when

trying to enter the house, had fallen unconscious in the garden.

He claimed that during the past few days, he had spent about 15 to 20

minutes each sniffing thinner. He had been treated for petrol sniffing at the

age of nine where he had been strongly addicted to the smell, but there was

no history of the loss of consciousness or seizures (a sudden, uncontrolled

electrical disturbance in the brain which can cause changes in one's behaviour, movements or feelings, and in the levels of consciousness). He

had been managed with behavioural therapy, and had been off the habit for

the past three years. He also claimed that he liked sniffing sanitizer fluids.

The basic blood investigations, including random blood sugar, full blood

count, renal (relating to the kidneys) function tests, aspartate transaminase

(a blood test that is used to diagnose liver damage as aspartate

transaminase is an enzyme [proteins that act as biological catalysts by

accelerating chemical reactions] that is released when one's liver or muscles

are damaged) and alanine transaminase (an enzyme found mostly in the

liver where the alanine transaminase test measures the amount of alanine

transaminase in the blood because when the liver cells are damaged, they

release alanine transaminase into the bloodstream with high levels of

alanine transaminase in the blood likely being an indicator of a liver related

injury or disease) were normal.

The electrocardiogram (or ECG, records the electrical signal from the heart

to check for different heart conditions where electrodes are placed on the

chest to record the heart's electrical signals which cause the heart to beat)

was normal with no arrhythmias (an abnormality of the heart's rhythm

where it may beat too slowly, too quickly, or irregularly) and normal

Corrected QT (the QT interval is a measurement made on an

electrocardiogram used to assess some of the electrical properties of the

heart) Interval (the Corrected QT Interval adjusts the QT interval correctly for

heart rate related extremes).

Electroencephalography (or EEG, a recording of brain activity during which

small sensors are attached to the scalp to pick up the electrical signals

produced by the brain and these signals are recorded by a machine) was

done to exclude abnormal electrical activity in the brain and it was normal.

Psychiatric referral was done and he was started on cognitive behavioural

therapy. Thinner is a volatile solvent, which contains various components such as

toluene (a substituted aromatic hydrocarbon and is a colourless, water

insoluble liquid), hexane (an organic compound), acetone (an organic

compound), methanol (a toxic alcohol that is used industrially), xylene (a

colourless, flammable liquid), benzene (a chemical that is colourless or a

light yellow liquid at room temperature), butyl acetate (an organic

compound), aromatics (hydrocarbons), and propyl acetate (an organic

compound).

Toluene and acetone are considered to be the major constituents. Toluene is

a well known neurotoxic agent as it also has effects on the respiratory,

cardiovascular, renal, haematologic, and metabolic (the process the body

uses to get or make energy from the food one eats) systems and also on the

skin, liver and eyes, and is readily absorbed by the lungs where in children,

the absorption is more as they have a greater lung surface area, body weight

ratio, and an increased minute volume, and weight ratio.

The adverse effects caused by toluene include effects on the central nervous

system (headache, dizziness, ataxia [poor muscle control that causes clumsy

voluntary movements and may cause difficulty with walking and balance,

hand co-ordination, speech and swallowing, and eye movements],

drowsiness [a feeling of being sleepy and lethargic], euphoria [a feeling or

state of intense excitement and happiness], hallucinations [false perceptions

of sensory experiences], tremors [an involuntary quivering movement],

seizures and coma [a persistent vegetative state which is a profound or deep

state of unconsciousness]), effects on the cardiovascular system (ventricular

arrhythmias [abnormal heartbeats that originate in the lower heart

chambers, called the ventricles, and these cause one’s heart to beat too fast,

which prevents oxygen rich blood from circulating to the brain and body and

may result in cardiac arrest]), respiratory effects (aspiration [the action or

process of drawing breath], chemical pneumonitis [inflammation of the lungs or breathing difficulty due to inhaling chemical fumes or breathing in

and choking on certain chemicals]), renal effects (haematuria [the presence

of blood in a person’s urine] and proteinuria [high levels of protein in one's

urine] after massive inhalation, renal tubular acidosis [occurs when the

kidneys do not remove acids from the blood into the urine as they should

and when the acid level in the blood then becomes too high, the condition is

called acidosis], glomerulonephritis [damage to the tiny filters inside one's

kidneys which are the glomeruli], myoglobinuria [the presence of an excess

amount of myoglobin {a protein that is found in one's striated muscles}

{highly organised tissues that convert chemical energy to physical work

where the primary function is to generate force and contract in order to

support respiration, locomotion, and posture and to pump blood throughout

the body}, the main function of which is to supply oxygen to the cells in

one's muscles} in the urine], and renal failure), haematologic effects (bone

marrow depression [decreased number of hematopoietic {the formation of

blood cellular components} cells in the bone marrow]) and ocular (of or

connected with the eyes or vision) effects (blepharospasm [blinking or other

eyelid based movements, like twitching, that one cannot control],

conjunctivitis [an inflammation or infection of the transparent

membrane/conjunctiva that lines the eyelid and covers the white part of the

eyeball], keratitis [an inflammation of the cornea which is the clear, dome

shaped window located at the front of the eye that covers the iris {thin,

annular structure in the eye, responsible for controlling the diameter and

size of the pupil} and pupil {a black hole located in the centre of the iris of

the eye}]).

During recovery, patients might continue to have ataxia, drowsiness, dilated

(make or become wider, larger, or more open) and sluggish pupils, and have

decreased or absent deep tendon reflexes (the stretch action and the muscle

response involved). Deaths have been reported following thinner inhalation. There is no exact data regarding inhalant abuse in Sri Lanka. However, perK kozel et al., evidence worldwide and also in other Asian countries, show that

it is a significant health problem.