PETROL SNIFFERS ENCEPHALOPATHY - A STUDY OF 25 PATIENTS

Objectives: To determine the clinical features, response to treatment and outcome of petrol sniffers presenting to Perth's teaching hospitals. Design: Retrospective study of all admissions to Perth's tertiary referral hospitals that were related to petrol sniffing from 1 January 1984 to 31 December 1991. Results: Twenty-five patients (22 male and 3 female) were admitted with a diagnosis of intentional petrol sniffing. Five presented with acute petrol intoxication as the result of an isolated action. The remaining 20 patients were ''chronic petrol sniffers''. The mean age was 17.7 years (range, 5-27 years). Twenty patients were Australian Aborigines, including 18 of 20 chronic petrol sniffers and the three females. In the chronic petrol sniffers, a high prevalence of seizures and an alarmingly high case fatality ratio (8 of 20), usually by sudden death, were found. An altered mental state was universal, manifesting as drowsiness, delirium or stupor. Generalised tonic-clonic seizures occurred in 14, three with status epilepticus. Myoclonus (9), chorea (8) and cerebellar ataxia (appendicular and truncal) (13) were common. High blood lead levels on presentation were associated with a poor prognosis (survivors v. deaths, P=0.002). Eighteen of the 20 patients were treated with specific agents to reduce the lead load, but the results were extremely disappointing. Conclusion: Petrol sniffing is an important cause of sickness and death in young people from some rural Aboriginal communities. It can cause sudden death or irreversible encephalopathy. Those severely affected have a poor prognosis, despite treatment. Effective strategies for prevention are needed.