been used successfully for severe bradycardia Blood pressure support is rarely necessary Inhalants Current Evidence The prevalence of inhalant abuse among young children and adolescents is related to their ready availability Patterns of abuse are also strikingly region specific, with the highest rates of abuse in the southwestern and southeastern United States Typically, the agents are abused by “huffing” or “bagging.” In huffing, the agent is placed into a rag or handkerchief, held under the nose, and then deeply inhaled With bagging, a common method of abuse at parties, the compound is placed into a large bag (e.g., garbage bag) with the drug user placing his or her head into the bag The psychoactive inhalants can be placed into three broad categories: (i) hydrocarbons, (ii) nitrous oxide, and (iii) nitrites The hydrocarbons can be subdivided further into the aliphatic hydrocarbons, the halogenated hydrocarbons, and solvents Regardless of the class, all inhalants possess the pharmacologic property of narcosis, leading to euphoria and light-headedness after inhalation The halogenated hydrocarbons are particularly dangerous because they sensitize the myocardium to catecholamines, potentially leading to myocardial irritability and cardiac dysrhythmias Clinical Considerations Several distinct profiles of inhalant abuse toxicity have been described Inebriation may be associated with mental status changes that include coma with respiratory arrest or aspiration The halogenated hydrocarbons all possess potent cardiotoxicity, as noted above, and have been associated with reports of spontaneous ventricular fibrillation in adolescents A syndrome known as sudden sniffing death has been described in adolescents who abuse inhalants and is most commonly reported with use of halogenated hydrocarbons Finally, the act of bagging is associated with the risk of simple asphyxia Finally, acute exposure to inhalants containing nitrites may lead to severe methemoglobinemia Other toxicities are associated with chronic inhalant abuse The solvents, particularly toluene, may lead to a syndrome that includes abdominal pain, muscle wasting, electrolyte disturbances (hypokalemia), and renal tubular acidosis Patients of chronic solvent abuse may also develop a leukoencephalomalacia with cerebral atrophy