High-Dose Toluene Inhalation-Induced Acute Toxic Encephalopathy Requiring Intensive Care: A Case Report

Toluene is an aromatic hydrocarbon widely abused via inhalation. High-dose exposure leads to acute toxic encephalopathy characterized by altered consciousness and severe metabolic disturbances. In this report, we present a 33-year-old male who was admitted to the emergency department with a Glasgow Coma Scale score of 5 following the inhalation of 15 adhesive containers. The patient was intubated and admitted to the intensive care unit (ICU), where initial evaluations revealed hyperchloremic normal anion gap metabolic acidosis and profound electrolyte imbalances. During clinical follow-up, generalized tonic-clonic seizures were observed despite normal neuroimaging findings. Following supportive care, electrolyte replacement, and antiepileptic therapy, clinical stabilization was achieved. Postextubation agitation and myoclonic seizures were successfully managed. This case highlights the multisystemic toxic effects of toluene and underscores the critical importance of intensive care monitoring in managing its clinical course and complications.