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Expanding the differential: toluene-induced toxicity
  1. Lavanya Dharmarajan1,
  2. Hussam Ammar2
  1. 1Medical School, McGovern Medical School, The University of Texas Heath Science Center at Houston, Houston, Texas, USA
  2. 2Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
  1. Correspondence to Dr. Hussam Ammar, hussam.ammar{at}


A 31-year-old woman presented to the hospital with generalised weakness and lower back and abdominal pain. The only significant finding on physical examination was the weakness of the legs. Laboratory analysis in the emergency department revealed that she was hypokalaemic with metabolic acidosis. She was treated with oral and intravenous potassium, which resolved her weakness. During the search for an explanation for her renal tubular acidosis, she said she was exposed to paint exposure while working on a friend's house. She was discharged on correction of her hypokalaemia, and a subsequent test revealed elevated blood toluene level.

  • poisoning
  • fluid electrolyte and acid-base disturbances

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  • Contributors HA and LD: managed the case, participated in writing the manuscript and reviewed the literature.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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